Provider Demographics
NPI:1548599186
Name:RENAISSANCE SLEEP SOLUTIONS LLC
Entity Type:Organization
Organization Name:RENAISSANCE SLEEP SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASILIOS
Authorized Official - Middle Name:C
Authorized Official - Last Name:COSTARAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-925-5400
Mailing Address - Street 1:PO BOX 161031
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-7031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2211 CROCKER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7602
Practice Address - Country:US
Practice Address - Phone:440-925-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty