MEDICARE: CENTRAL OHIO TMJD & DENTAL SLEEP THERAPY 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	122300000X	Dentist	15998	OH
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1952647828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OHIO TMJD & DENTAL SLEEP THERAPY LLC

Provider Business Mailing Address
First Line	:	149 W SCHROCK RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2831
Country	:	US
Telephone Number	:	614-890-1571
Fax Number	:	614-890-4518

Provider Business Practice Location Address
First Line	:	149 W SCHROCK RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-2831
Country	:	US
Telephone Number	:	614-890-1571
Fax Number	:	614-890-4518

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MICHAEL J BEZBATCHENKO
Credential	:	DDS
Telephone Number	:	614-890-1571

Provider Enumeration Date	:	12/21/2012
Last Update Date	:	11/16/2016

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