Provider Demographics
NPI:1346729688
Name:POWW SLEEP, PLLC
Entity Type:Organization
Organization Name:POWW SLEEP, PLLC
Other - Org Name:WHITE WOLF DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KULAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-304-1181
Mailing Address - Street 1:1221 DUNLAWTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8930
Mailing Address - Country:US
Mailing Address - Phone:386-304-1181
Mailing Address - Fax:386-304-6401
Practice Address - Street 1:1221 DUNLAWTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8930
Practice Address - Country:US
Practice Address - Phone:386-304-1181
Practice Address - Fax:386-304-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18671332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies