Provider Demographics
NPI:1992163703
Name:EAST BAY SLEEP MANAGEMENT
Entity type:Organization
Organization Name:EAST BAY SLEEP MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-339-2792
Mailing Address - Street 1:6116 MERCED AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2917
Mailing Address - Country:US
Mailing Address - Phone:925-339-2792
Mailing Address - Fax:925-339-3159
Practice Address - Street 1:6116 MERCED AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2917
Practice Address - Country:US
Practice Address - Phone:925-339-2792
Practice Address - Fax:925-339-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty