Provider Demographics
NPI:1124417480
Name:S. DANNEY DENTAL GROUP SLEEP MEDICINE, INC.
Entity Type:Organization
Organization Name:S. DANNEY DENTAL GROUP SLEEP MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:DANNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-703-7803
Mailing Address - Street 1:6386 ALVARADO CT STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4908
Mailing Address - Country:US
Mailing Address - Phone:619-286-4123
Mailing Address - Fax:
Practice Address - Street 1:6386 ALVARADO CT STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4908
Practice Address - Country:US
Practice Address - Phone:619-286-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB239618Medicaid
CACB239618Medicaid