Provider Demographics
NPI:1063023430
Name:WESTSIDE DENTAL SLEEP CENTER LLC
Entity Type:Organization
Organization Name:WESTSIDE DENTAL SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-221-2210
Mailing Address - Street 1:30701 LORAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6325
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:
Practice Address - Street 1:18611 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3205
Practice Address - Country:US
Practice Address - Phone:216-221-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4508862OtherOHIO BUSINESS LICENSE