Provider Demographics
NPI:1932527256
Name:CENTER FOR DENTAL SLEEP MEDICINE,INC
Entity Type:Organization
Organization Name:CENTER FOR DENTAL SLEEP MEDICINE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLOSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-776-0760
Mailing Address - Street 1:428 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502
Mailing Address - Country:US
Mailing Address - Phone:785-776-0760
Mailing Address - Fax:
Practice Address - Street 1:1136 EAST STUART
Practice Address - Street 2:#3140
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:855-774-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05754332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment