Provider Demographics
NPI:1497490965
Name:SLEEP WELL OKLAHOMA LLC
Entity Type:Organization
Organization Name:SLEEP WELL OKLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMELIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERVILOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-588-2368
Mailing Address - Street 1:3621 NW 63RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2041
Mailing Address - Country:US
Mailing Address - Phone:405-848-8839
Mailing Address - Fax:
Practice Address - Street 1:3621 NW 63RD ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2041
Practice Address - Country:US
Practice Address - Phone:405-848-8839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7038OtherLICENSE