| Organization Name: | SLEEP OPTIMA DENTAL NETWORK, LLC |
| NPI Number: | 1205230141 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH MUTTILLO (MANAGER) |
| Mailing Address: | 26380 Curtiss Wright Pkwy Suite 303 Richmond Hts |
| State: | OH US |
| Postal Code: | 441434407 |
| Phone Number: | 8776431613 |
| Fax Number: | 8776884006 |
| NPI Enumeration Date: | 10/21/2014 |
| NPI Last Update Date: | 10/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Sleep Disorder Diagnostic |
| Taxonomy Definition: | |