Provider Demographics
NPI:1205265386
Name:MODERN SLEEP SOLUTIONS PLLC
Entity type:Organization
Organization Name:MODERN SLEEP SOLUTIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FEDOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-538-9780
Mailing Address - Street 1:3447 RENNER RD # 100A
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0051
Mailing Address - Country:US
Mailing Address - Phone:972-496-0515
Mailing Address - Fax:469-440-9198
Practice Address - Street 1:3447 RENNER RD # 100A
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-0051
Practice Address - Country:US
Practice Address - Phone:972-496-0515
Practice Address - Fax:469-440-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6985750001Medicare NSC