Provider Demographics
NPI:1396057584
Name:SLEEP APNEA PROFESSIONALS LLC
Entity type:Organization
Organization Name:SLEEP APNEA PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICO
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-706-1499
Mailing Address - Street 1:PO BOX 91627
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-1627
Mailing Address - Country:US
Mailing Address - Phone:251-706-1499
Mailing Address - Fax:
Practice Address - Street 1:1055 MONTLIMAR DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1708
Practice Address - Country:US
Practice Address - Phone:251-706-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5733C122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-13806OtherBCBS LOCATION ID
AL134191Medicaid
AL00510BSOtherBCBS
AL510DNOtherBCBS
AL510DNOtherBCBS