Provider Demographics
NPI:1871097139
Name:INNOVATIVE SLEEP CONCEPTS
Entity type:Organization
Organization Name:INNOVATIVE SLEEP CONCEPTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:775-477-5337
Mailing Address - Street 1:730 SANDHILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8963
Mailing Address - Country:US
Mailing Address - Phone:775-477-5337
Mailing Address - Fax:775-360-4131
Practice Address - Street 1:730 SANDHILL RD STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8963
Practice Address - Country:US
Practice Address - Phone:775-477-5337
Practice Address - Fax:775-360-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID