Provider Demographics
NPI:1437689940
Name:MEDI-DENT, INC.
Entity Type:Organization
Organization Name:MEDI-DENT, INC.
Other - Org Name:DENTAL SLEEP MADE SIMPLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-450-0281
Mailing Address - Street 1:1050 15TH ST SW STE 2
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5677
Mailing Address - Country:US
Mailing Address - Phone:641-450-0281
Mailing Address - Fax:641-450-0284
Practice Address - Street 1:1050 15TH ST. S.W.
Practice Address - Street 2:SUITE 2
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-450-0281
Practice Address - Fax:641-450-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty