Provider Demographics
NPI:1346414075
Name:DENTAL, SLEEP, AND MIGRAINE TREATMENT CENTER
Entity Type:Organization
Organization Name:DENTAL, SLEEP, AND MIGRAINE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:REDMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-463-7311
Mailing Address - Street 1:PO BOX 2239
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47996
Mailing Address - Country:US
Mailing Address - Phone:765-463-7311
Mailing Address - Fax:765-464-8364
Practice Address - Street 1:510 W NAVAJO ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1999
Practice Address - Country:US
Practice Address - Phone:765-463-7311
Practice Address - Fax:765-464-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental