Provider Demographics
NPI:1760935332
Name:ABSOLUTE SLEEP TREATMENT CENTER
Entity Type:Organization
Organization Name:ABSOLUTE SLEEP TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:SPALDING
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-718-0002
Mailing Address - Street 1:2065 AIRWAY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3656
Mailing Address - Country:US
Mailing Address - Phone:928-718-0002
Mailing Address - Fax:928-718-0007
Practice Address - Street 1:2065 AIRWAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3656
Practice Address - Country:US
Practice Address - Phone:928-718-0002
Practice Address - Fax:928-718-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4670261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic