Provider Demographics
NPI:1952647828
Name:CENTRAL OHIO TMJD & DENTAL SLEEP THERAPY LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO TMJD & DENTAL SLEEP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEZBATCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-890-1571
Mailing Address - Street 1:149 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2831
Mailing Address - Country:US
Mailing Address - Phone:614-890-1571
Mailing Address - Fax:614-890-4518
Practice Address - Street 1:149 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2831
Practice Address - Country:US
Practice Address - Phone:614-890-1571
Practice Address - Fax:614-890-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15998122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6733530001Medicare NSC