Provider Demographics
NPI:1366904708
Name:TMJ & SLEEP THERAPY CENTRE OF MACOMB COUNTY, PLLC
Entity type:Organization
Organization Name:TMJ & SLEEP THERAPY CENTRE OF MACOMB COUNTY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-949-5363
Mailing Address - Street 1:50475 GRATIOT
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051
Mailing Address - Country:US
Mailing Address - Phone:586-949-5363
Mailing Address - Fax:586-949-5366
Practice Address - Street 1:50475 GRATIOT
Practice Address - Street 2:SUITE 4
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051
Practice Address - Country:US
Practice Address - Phone:586-949-5363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TMJ & SLEEP THERAPY CENTRE OF MACOMB COU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty