Provider Demographics
NPI:1194181560
Name:SLEEP SOLUTIONS OF CENTRAL ILLINOIS
Entity Type:Organization
Organization Name:SLEEP SOLUTIONS OF CENTRAL ILLINOIS
Other - Org Name:TARA M GRIFFIN DMD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-319-6568
Mailing Address - Street 1:2309 E. EMPIRE ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8900
Mailing Address - Country:US
Mailing Address - Phone:309-319-6568
Mailing Address - Fax:309-664-0352
Practice Address - Street 1:2309 E. EMPIRE ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-8900
Practice Address - Country:US
Practice Address - Phone:309-319-6568
Practice Address - Fax:309-664-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty