Provider Demographics
NPI:1396019261
Name:WESTERN OHIO DENTAL SLEEP MEDICINE
Entity Type:Organization
Organization Name:WESTERN OHIO DENTAL SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:937-626-4770
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 207-A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-771-2973
Mailing Address - Fax:937-836-7394
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 207-A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-771-2973
Practice Address - Fax:937-836-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.021271332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment