Provider Demographics
NPI:1720545007
Name:COLORADO SPRINGS SLEEP AND WELLNESS, LLC
Entity Type:Organization
Organization Name:COLORADO SPRINGS SLEEP AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:BARDIN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-475-2511
Mailing Address - Street 1:595 CHAPEL HILLS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1024
Mailing Address - Country:US
Mailing Address - Phone:719-475-2511
Mailing Address - Fax:719-475-8425
Practice Address - Street 1:595 CHAPEL HILLS DR STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1024
Practice Address - Country:US
Practice Address - Phone:719-475-2511
Practice Address - Fax:719-475-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO106234OtherSTATE LICENSE