Provider Demographics
NPI:1194110064
Name:OPTIMAL SLEEP SOLUTIONS LLC
Entity type:Organization
Organization Name:OPTIMAL SLEEP SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-594-9787
Mailing Address - Street 1:11825 STATE ROUTE 40
Mailing Address - Street 2:100
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-8842
Mailing Address - Country:US
Mailing Address - Phone:309-839-9961
Mailing Address - Fax:
Practice Address - Street 1:8110 W UNION HILLS DR
Practice Address - Street 2:SUITE 430
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8177
Practice Address - Country:US
Practice Address - Phone:623-594-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty