Provider Demographics
NPI:1265972137
Name:DENTAL SLEEP THERAPY OF GREATER CINCINNATI PSC
Entity type:Organization
Organization Name:DENTAL SLEEP THERAPY OF GREATER CINCINNATI PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-282-1632
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022-0605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:265 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2186
Practice Address - Country:US
Practice Address - Phone:859-371-4620
Practice Address - Fax:859-746-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
KY7616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty