Provider Demographics
NPI:1659648871
Name:SLEEP APNEA PROFESSIONALS LLC
Entity Type:Organization
Organization Name:SLEEP APNEA PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICO
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-306-5995
Mailing Address - Street 1:PO BOX 91627
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-1627
Mailing Address - Country:US
Mailing Address - Phone:865-306-5995
Mailing Address - Fax:877-568-5379
Practice Address - Street 1:6311 KINGSTON PIKE
Practice Address - Street 2:SUITE 8-W
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-306-5995
Practice Address - Fax:877-568-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525929Medicaid
TN1525929Medicaid