Provider Demographics
NPI:1881001477
Name:SLEEPY SMILES OF WASHINGTON
Entity Type:Organization
Organization Name:SLEEPY SMILES OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:208-316-6424
Mailing Address - Street 1:1115 8TH AVE E
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-2139
Mailing Address - Country:US
Mailing Address - Phone:208-316-6424
Mailing Address - Fax:
Practice Address - Street 1:212 S 92ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9361
Practice Address - Country:US
Practice Address - Phone:208-316-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 6048071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty