Provider Demographics
NPI:1093224032
Name:GEORGE S. YATROS DENTAL SLEEP, LLC
Entity Type:Organization
Organization Name:GEORGE S. YATROS DENTAL SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:YATROS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-757-4642
Mailing Address - Street 1:402 43RD ST W STE A
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2953
Mailing Address - Country:US
Mailing Address - Phone:941-757-4642
Mailing Address - Fax:844-868-4098
Practice Address - Street 1:1 DAVIS BLVD STE 103B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3463
Practice Address - Country:US
Practice Address - Phone:941-757-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE S YATROS DENTAL SLEEP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12435332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies