Provider Demographics
NPI:1649741885
Name:MANSFIELD DENTAL SLEEP SOLUTION
Entity type:Organization
Organization Name:MANSFIELD DENTAL SLEEP SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/SOLE PROPERITOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:419-638-3131
Mailing Address - Street 1:2558 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1209
Mailing Address - Country:US
Mailing Address - Phone:419-683-3131
Mailing Address - Fax:
Practice Address - Street 1:2558 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1209
Practice Address - Country:US
Practice Address - Phone:419-683-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANSFIELD DENTAL SLEEP SOLUTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies