MEDICARE: HOLLOWBROOK SLEEP SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7185	CO

General Provider Information

NPI Number	:	1881025880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLLOWBROOK SLEEP SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2164 HOLLOWBROOK DRIVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-344-9574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2164 HOLLOWBROOK DRIVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-633-0049
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	DR. LANNY LEE SMITH
Credential	:	DDS
Telephone Number	:	719-633-0049

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	04/19/2016

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