Provider Demographics
NPI:1508210899
Name:SDM SLEEPCARE INC
Entity Type:Organization
Organization Name:SDM SLEEPCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:DHANANJAYA
Authorized Official - Last Name:MHASKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-973-3492
Mailing Address - Street 1:5436 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4206
Mailing Address - Country:US
Mailing Address - Phone:909-465-5551
Mailing Address - Fax:909-465-5191
Practice Address - Street 1:5436 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4206
Practice Address - Country:US
Practice Address - Phone:909-465-5551
Practice Address - Fax:909-465-5191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40278122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Multi-Specialty