Provider Demographics
NPI:1316598311
Name:PRAIRIE SLEEP CENTER LLC
Entity Type:Organization
Organization Name:PRAIRIE SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-546-0412
Mailing Address - Street 1:2900 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6418
Mailing Address - Country:US
Mailing Address - Phone:217-546-0412
Mailing Address - Fax:217-546-0919
Practice Address - Street 1:2900 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6418
Practice Address - Country:US
Practice Address - Phone:217-546-0412
Practice Address - Fax:217-546-0919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TANYA L DESANTO DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-23
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1285778522OtherDR. TANYA L. DESANTO