Provider Demographics
NPI:1073227294
Name:MOONLIGHT SLEEP REMEDIES INC
Entity Type:Organization
Organization Name:MOONLIGHT SLEEP REMEDIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIYAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-705-8648
Mailing Address - Street 1:500 NW 10TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3364
Mailing Address - Country:US
Mailing Address - Phone:503-505-4624
Mailing Address - Fax:
Practice Address - Street 1:500 NW 10TH AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3364
Practice Address - Country:US
Practice Address - Phone:503-505-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies