Provider Demographics
NPI:1932929239
Name:DENTAL SLEEP THERAPY OF MACON LLC
Entity type:Organization
Organization Name:DENTAL SLEEP THERAPY OF MACON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-722-9865
Mailing Address - Street 1:105 BROADLEAF DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1921
Mailing Address - Country:US
Mailing Address - Phone:478-722-1111
Mailing Address - Fax:866-494-6123
Practice Address - Street 1:4885 RIVERSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1164
Practice Address - Country:US
Practice Address - Phone:478-305-7282
Practice Address - Fax:866-494-6123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty