MEDICARE: DENTAL 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1881251544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SLEEP SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	337 HAMPTON GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1722
Country	:	US
Telephone Number	:	718-984-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 HAMPTON GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1722
Country	:	US
Telephone Number	:	718-984-1720
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIVIAN DAMARIS BOTERO-NEBEL
Credential	:	DMD
Telephone Number	:	718-984-1729

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	09/20/2019

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