Provider Demographics
NPI:1326404583
Name:SLEEP EASY DENTAL SPA LLC
Entity Type:Organization
Organization Name:SLEEP EASY DENTAL SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:VERBANIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-872-5737
Mailing Address - Street 1:127 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1386
Mailing Address - Country:US
Mailing Address - Phone:330-759-4550
Mailing Address - Fax:330-759-4548
Practice Address - Street 1:2000 MILTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-9793
Practice Address - Country:US
Practice Address - Phone:330-872-5737
Practice Address - Fax:330-872-7400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP EASY DENTAL SPA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-04
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15223261Q00000X
OH30.15233332B00000X
OH30.024283332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies