MEDICARE: CENTER FOR DENTAL SLEEP MEDICINE,INC

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)	05754	CO

General Provider Information

NPI Number	:	1932527256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR DENTAL SLEEP MEDICINE,INC

Provider Business Mailing Address
First Line	:	428 HOUSTON ST
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502
Country	:	US
Telephone Number	:	785-776-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1136 EAST STUART
Second Line	:	#3140
City	:	FT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	855-774-0760
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MICHAELA L CLOSSON
Credential	:
Telephone Number	:	785-776-0760

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	04/23/2014

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