Provider Demographics
NPI:1649663139
Name:SLEEPY HILLS DENTAL
Entity type:Organization
Organization Name:SLEEPY HILLS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-998-7000
Mailing Address - Street 1:3545 ST. JOHNS BLUFF RD. S.
Mailing Address - Street 2:SUITE 352
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:904-998-7000
Mailing Address - Fax:904-998-7702
Practice Address - Street 1:4145 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3830
Practice Address - Country:US
Practice Address - Phone:863-858-3891
Practice Address - Fax:904-998-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization