Provider Demographics
NPI:1841577095
Name:FLORIDA SNORING & APNEA SOLUTIONS LLC
Entity Type:Organization
Organization Name:FLORIDA SNORING & APNEA SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-675-6769
Mailing Address - Street 1:555 W GRANADA BLVD
Mailing Address - Street 2:STE C-2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9485
Mailing Address - Country:US
Mailing Address - Phone:386-675-6769
Mailing Address - Fax:386-675-6770
Practice Address - Street 1:555 W GRANADA BLVD
Practice Address - Street 2:STE C-2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9485
Practice Address - Country:US
Practice Address - Phone:386-675-6769
Practice Address - Fax:386-675-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18198261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6627860001Medicare NSC