Provider Demographics
NPI:1558801480
Name:NORTHEAST OHIO CENTER FOR DENTAL SLEEP MEDICINE LLC
Entity Type:Organization
Organization Name:NORTHEAST OHIO CENTER FOR DENTAL SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DESATNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-831-1170
Mailing Address - Street 1:22901 MILLCREEK BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5728
Mailing Address - Country:US
Mailing Address - Phone:216-831-1170
Mailing Address - Fax:
Practice Address - Street 1:22901 MILLCREEK BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5728
Practice Address - Country:US
Practice Address - Phone:216-831-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-25
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH 30-023233261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1417269820OtherUPIN