Provider Demographics
NPI:1740751460
Name:AUDUBON DENTAL SLEEP SOLUTIONS LLC
Entity Type:Organization
Organization Name:AUDUBON DENTAL SLEEP SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:REINICKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-597-6300
Mailing Address - Street 1:2960 N CIRCLE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1163
Mailing Address - Country:US
Mailing Address - Phone:719-597-6300
Mailing Address - Fax:719-597-8266
Practice Address - Street 1:2960 N CIRCLE DR STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1163
Practice Address - Country:US
Practice Address - Phone:719-597-6300
Practice Address - Fax:719-597-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty