Provider Demographics
NPI:1356700546
Name:ASPEN DENTAL SLEEP MEDICINE
Entity type:Organization
Organization Name:ASPEN DENTAL SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, D,ABDSM
Authorized Official - Phone:970-319-2999
Mailing Address - Street 1:PO BOX 3251
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-3251
Mailing Address - Country:US
Mailing Address - Phone:970-319-2999
Mailing Address - Fax:
Practice Address - Street 1:1460 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8411
Practice Address - Country:US
Practice Address - Phone:970-319-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment