Provider Demographics
NPI:1205230141
Name:SLEEP OPTIMA DENTAL NETWORK, LLC
Entity Type:Organization
Organization Name:SLEEP OPTIMA DENTAL NETWORK, LLC
Other - Org Name:SLEEP OPTIMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-643-1613
Mailing Address - Street 1:26380 CURTISS WRIGHT PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-4407
Mailing Address - Country:US
Mailing Address - Phone:877-643-1613
Mailing Address - Fax:877-688-4006
Practice Address - Street 1:26380 CURTISS WRIGHT PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-4407
Practice Address - Country:US
Practice Address - Phone:877-643-1613
Practice Address - Fax:877-688-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic