Swallowtail Sleep Center LLC
Dentist in Massillon, OH. Organization (NPI-2).
NPI number1164066320
StatusActive
Last updated in NPPESSep 17, 2020
Details
- NPI
- 1164066320
- Entity type
- Organization (NPI-2)
- Legal business name
- Swallowtail Sleep Center LLC
- Organization subpart
- No
- Enumeration date
- Oct 31, 2019
- Certification date
- Aug 17, 2020
- Last updated
- Sep 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – |
Practice location
2400 Wales Ave Nw Ste JMassillon, OH 44646-2367
Phone 330-904-7753
Mailing address
2400 Wales Ave Nw Ste JMassillon, OH 44646-2367
Phone 330-832-4533 · Fax 330-832-3500
Authorized official
Richard Mosher
Owner
3309047753
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