Provider Demographics
NPI:1629353941
Name:RESTORATIVE SLEEP SOLUTIONS
Entity Type:Organization
Organization Name:RESTORATIVE SLEEP SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-264-0286
Mailing Address - Street 1:3630 MADACA LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2057
Mailing Address - Country:US
Mailing Address - Phone:813-264-0286
Mailing Address - Fax:813-960-4667
Practice Address - Street 1:3630 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2057
Practice Address - Country:US
Practice Address - Phone:813-264-0286
Practice Address - Fax:813-960-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 12750332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies