Provider Demographics
NPI:1629490248
Name:THE CENTER FOR DENTAL SLEEP MEDICINE
Entity Type:Organization
Organization Name:THE CENTER FOR DENTAL SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CANTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-509-7486
Mailing Address - Street 1:2207 OREGON PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4668
Mailing Address - Country:US
Mailing Address - Phone:717-509-7486
Mailing Address - Fax:717-509-8527
Practice Address - Street 1:310 N LANCASTER ST
Practice Address - Street 2:
Practice Address - City:JONESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17038-8909
Practice Address - Country:US
Practice Address - Phone:717-509-7486
Practice Address - Fax:717-509-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031346L335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6706950001Medicare NSC
PA256322Medicare PIN