| Moonlight Sleep Remedies Inc | |
|
500 Nw 10th Ave Ste A Portland OR 97209-3364 | |
| (503) 505-4624 | |
| Not Available |
| Full Name | Moonlight Sleep Remedies Inc |
|---|---|
| Speciality | Dentist |
| Location | 500 Nw 10th Ave Ste A, Portland, Oregon |
| Authorized Official Name and Position | Mika Miyamoto (DENTIST / OWNER) |
| Authorized Official Contact | 5037058648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonlight Sleep Remedies Inc 500 Nw 10th Ave Ste A Portland OR 97209-3364 Ph: (503) 505-4624 | Moonlight Sleep Remedies Inc 500 Nw 10th Ave Ste A Portland OR 97209-3364 Ph: (503) 505-4624 |
| NPI Number | 1073227294 |
|---|---|
| Provider Enumeration Date | 01/11/2023 |
| Last Update Date | 04/02/2024 |
| Medicare PECOS PAC ID | 2466818372 |
|---|---|
| Medicare Enrollment ID | O20240421000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073227294 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
| Provider Name | Mika Miyamoto |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1891792271 PECOS PAC ID: 8426423138 Enrollment ID: I20240421000151 |
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