Provider Demographics
NPI:1083350581
Name:GREAT LAKES SLEEP AND OROFACIAL PAIN CLINIC
Entity Type:Organization
Organization Name:GREAT LAKES SLEEP AND OROFACIAL PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SABAGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-493-1133
Mailing Address - Street 1:16501 FALDA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1412
Mailing Address - Country:US
Mailing Address - Phone:310-493-1133
Mailing Address - Fax:
Practice Address - Street 1:75 BARCLAY CIR STE 205
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5821
Practice Address - Country:US
Practice Address - Phone:310-493-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-08
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty