Provider Demographics
NPI:1982465878
Name:VALDOSTA CENTER FOR SLEEP APNEA SNORING & TMJ LLC
Entity Type:Organization
Organization Name:VALDOSTA CENTER FOR SLEEP APNEA SNORING & TMJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-247-0200
Mailing Address - Street 1:2704 N OAK ST BLDG C1
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1796
Mailing Address - Country:US
Mailing Address - Phone:229-247-0200
Mailing Address - Fax:229-241-7474
Practice Address - Street 1:2704 N OAK ST BLDG C1
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1796
Practice Address - Country:US
Practice Address - Phone:229-247-0200
Practice Address - Fax:229-241-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty