Provider Demographics
NPI:1740794445
Name:DENTAL SLEEP MEDICINE OF CENTRAL CONNECTICUT, LLC
Entity Type:Organization
Organization Name:DENTAL SLEEP MEDICINE OF CENTRAL CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALONIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-346-6737
Mailing Address - Street 1:955 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5153
Mailing Address - Country:US
Mailing Address - Phone:860-346-6737
Mailing Address - Fax:860-704-0239
Practice Address - Street 1:955 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5153
Practice Address - Country:US
Practice Address - Phone:860-346-6737
Practice Address - Fax:860-704-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5646OtherLICENSE
1477580538OtherNPI