Provider Demographics
NPI:1811531007
Name:TMJ & SLEEP THERAPY CENTRE OF FORT WAYNE, LLC
Entity type:Organization
Organization Name:TMJ & SLEEP THERAPY CENTRE OF FORT WAYNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-434-0099
Mailing Address - Street 1:9121 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5753
Mailing Address - Country:US
Mailing Address - Phone:260-434-0099
Mailing Address - Fax:260-434-0799
Practice Address - Street 1:9121 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5753
Practice Address - Country:US
Practice Address - Phone:260-434-0099
Practice Address - Fax:260-434-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty