Provider Demographics
NPI:1952020604
Name:RESTFULLY
Entity Type:Organization
Organization Name:RESTFULLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-610-5708
Mailing Address - Street 1:4344 STAFFORD CT
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5559
Mailing Address - Country:US
Mailing Address - Phone:702-610-5708
Mailing Address - Fax:
Practice Address - Street 1:507 S WASHINGTON ST STE 190
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2604
Practice Address - Country:US
Practice Address - Phone:702-610-5708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTFULLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty