Provider Demographics
NPI:1396217717
Name:UNITED DENTAL SLEEP MEDICINE, PLLC
Entity type:Organization
Organization Name:UNITED DENTAL SLEEP MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-625-4066
Mailing Address - Street 1:5823 SPINNAKER COVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2128
Mailing Address - Country:US
Mailing Address - Phone:804-625-4066
Mailing Address - Fax:
Practice Address - Street 1:9020 LORTON STATION BLVD UNIT F104
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4750
Practice Address - Country:US
Practice Address - Phone:804-625-4066
Practice Address - Fax:804-414-7491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment