Provider Demographics
NPI:1083230494
Name:SLEEPY TOOTH ORTHODONTICS LLC
Entity Type:Organization
Organization Name:SLEEPY TOOTH ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLEBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-836-3750
Mailing Address - Street 1:1250 PEOPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5701
Mailing Address - Country:US
Mailing Address - Phone:302-392-2449
Mailing Address - Fax:302-392-2499
Practice Address - Street 1:26670 CENTERVIEW DR UNIT 19
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3584
Practice Address - Country:US
Practice Address - Phone:302-297-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty