Basic Information
| Provider Information | |||||||||
| NPI: | 1871164020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY SLEEP SOLUTIONS CHARLESTON LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1710 OLD TROLLEY RD STE B | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438710711 | ||||||||
| FaxNumber: | 8438710617 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 LOCKWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294011126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437228500 | ||||||||
| FaxNumber: | 8435774464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | AMMONS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8438710711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMMONS DENTAL BY DESIGN - WENTWORTH, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.