Provider Demographics
NPI:1114578663
Name:MIDDESEX DENTAL SLEEP MEDICINE LLC
Entity Type:Organization
Organization Name:MIDDESEX DENTAL SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-346-3443
Mailing Address - Street 1:410 SAYBROOK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4777
Mailing Address - Country:US
Mailing Address - Phone:860-346-3443
Mailing Address - Fax:860-343-9401
Practice Address - Street 1:410 SAYBROOK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4777
Practice Address - Country:US
Practice Address - Phone:860-346-3443
Practice Address - Fax:860-343-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty