Provider Demographics
NPI:1720423197
Name:DENTAL SLEEP MEDICINE OF NORTHERN KENTUCKY, PLLC
Entity Type:Organization
Organization Name:DENTAL SLEEP MEDICINE OF NORTHERN KENTUCKY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MARLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-283-1055
Mailing Address - Street 1:7303 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1903
Mailing Address - Country:US
Mailing Address - Phone:859-283-1055
Mailing Address - Fax:859-283-0036
Practice Address - Street 1:7303 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1903
Practice Address - Country:US
Practice Address - Phone:859-283-1055
Practice Address - Fax:859-283-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7299122300000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6782510001Medicare NSC