Provider Demographics
NPI:1003250416
Name:REFRESH SNORING AND SLEEP APNEA CENTER, PC
Entity Type:Organization
Organization Name:REFRESH SNORING AND SLEEP APNEA CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:EHTESSABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-342-3806
Mailing Address - Street 1:3740 DACORO LN
Mailing Address - Street 2:SUITE #140
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2503
Mailing Address - Country:US
Mailing Address - Phone:719-342-3806
Mailing Address - Fax:
Practice Address - Street 1:3740 DACORO LN
Practice Address - Street 2:SUITE #140
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2503
Practice Address - Country:US
Practice Address - Phone:719-342-3806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty