Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Sleep Disorder Diagnostic |
261QS1200X |
| NPI Number | 1760935332 |
||||
| LBN Legal business name | ABSOLUTE SLEEP TREATMENT CENTER | ||||
| Authorized official | THEODORE KIMBALL - (OWNER/DENTIST) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 07/29/2016 | ||||
| Last updated | 07/29/2016 - About 10 years ago | ||||
| Identifiers |
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