Provider Demographics
NPI:1174037436
Name:DESERT MOUNTAIN SLEEP SOLUTIONS LLC
Entity Type:Organization
Organization Name:DESERT MOUNTAIN SLEEP SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILDUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-391-4107
Mailing Address - Street 1:7205 E SOUTHERN AVE STE A-122
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2790
Mailing Address - Country:US
Mailing Address - Phone:602-391-4107
Mailing Address - Fax:
Practice Address - Street 1:6920 E SHEA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6185
Practice Address - Country:US
Practice Address - Phone:480-991-3244
Practice Address - Fax:480-991-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental