Provider Demographics
NPI:1003969288
Name:THE CENTER FOR SLEEP APNEA AND TMJ PA
Entity Type:Organization
Organization Name:THE CENTER FOR SLEEP APNEA AND TMJ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:208-376-3600
Mailing Address - Street 1:1718 S. MILLENNIUM WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1511
Mailing Address - Country:US
Mailing Address - Phone:208-376-3600
Mailing Address - Fax:208-376-3616
Practice Address - Street 1:1718 S. MILLENNIUM WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1511
Practice Address - Country:US
Practice Address - Phone:208-376-3600
Practice Address - Fax:208-376-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD31991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU80194Medicare UPIN
ID1369234Medicare ID - Type Unspecified
ID6167560001Medicare NSC