Provider Demographics
NPI:1326604463
Name:DENTAL SLEEP MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DENTAL SLEEP MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-715-3926
Mailing Address - Street 1:5016 HIGHWAY 28 E
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4737
Mailing Address - Country:US
Mailing Address - Phone:318-448-4540
Mailing Address - Fax:318-484-2837
Practice Address - Street 1:5016 HIGHWAY 28 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4737
Practice Address - Country:US
Practice Address - Phone:318-448-4540
Practice Address - Fax:318-484-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental