Provider Demographics
NPI:1821656471
Name:SLEEPY TOOTH SEDATION, L.L.C.
Entity Type:Organization
Organization Name:SLEEPY TOOTH SEDATION, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERNOBYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-392-2449
Mailing Address - Street 1:1250 PEOPLES PLZ
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5701
Mailing Address - Country:US
Mailing Address - Phone:302-392-2449
Mailing Address - Fax:302-392-2499
Practice Address - Street 1:2304 CONCORD PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2912
Practice Address - Country:US
Practice Address - Phone:302-791-3750
Practice Address - Fax:302-884-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty