Provider Demographics
NPI:1871900977
Name:MID-MISSOURI INSTITUTE OF DENTAL SLEEP MEDICINE LLC
Entity type:Organization
Organization Name:MID-MISSOURI INSTITUTE OF DENTAL SLEEP MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-282-8565
Mailing Address - Street 1:1505 CHAPEL HILL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 CHAPEL HILL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5506
Practice Address - Country:US
Practice Address - Phone:573-303-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty