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General NPI Number Information
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NPI Number | 1992163703
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Entity Type | Organization
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Legal Business Name | EAST BAY SLEEP MANAGEMENT
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 6116 MERCED AVE
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City | OAKLAND
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State | CA
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Zip | 94611-2917
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Country | US
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Telephone | 925-339-2792
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Fax | 925-339-3159
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Provider Business Mailing Address
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Address Line | 6116 MERCED AVE
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City | OAKLAND
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State | CA
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Zip | 94611-2917
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Country | US
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Telephone | 925-339-2792
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Fax | 925-339-3159
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Authorized Official
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Title or Position | ONWER
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Name | DR. KENNETH LLOYD CHILDERS
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Credential | DDS
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Telephone | 510-339-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22329
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License Number State | CA
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