Provider Demographics
NPI:1235509597
Name:DENTAL SLEEP THERAPY, A PROFESSIONAL DENTAL GROUP BY F BURRELL DDS
Entity Type:Organization
Organization Name:DENTAL SLEEP THERAPY, A PROFESSIONAL DENTAL GROUP BY F BURRELL DDS
Other - Org Name:DENTAL SLEEP THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-342-0899
Mailing Address - Street 1:30131 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2040
Mailing Address - Country:US
Mailing Address - Phone:949-342-0899
Mailing Address - Fax:949-495-0642
Practice Address - Street 1:30131 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2040
Practice Address - Country:US
Practice Address - Phone:949-342-0899
Practice Address - Fax:949-495-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD249501223G0001X
CAD277671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty