Provider Demographics
NPI:1164044889
Name:DEEP SLEEP DENTAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:DEEP SLEEP DENTAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GOODREAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-734-0482
Mailing Address - Street 1:3550 BAREBACK TRL
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7953
Mailing Address - Country:US
Mailing Address - Phone:386-677-7367
Mailing Address - Fax:386-738-3768
Practice Address - Street 1:111 S DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5165
Practice Address - Country:US
Practice Address - Phone:386-734-0482
Practice Address - Fax:386-738-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty