# LIVINGSTON DENTAL SLEEP THERAPY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629414255
- **Authorized official:** DR. BRIAN J PETERSBURG DDS (OWNER/DENTIST)
- **Authorized official phone:** (810) 227-4224

## Contact information

- **Practice address:** 8641 W GRAND RIVER AVE, SUITE 6, BRIGHTON, MI 48116-4353
- **Practice address phone:** (810) 227-4224
- **Practice address fax:** (810) 227-4660
- **Mailing address:** 8641 W GRAND RIVER AVE, SUITE 6, BRIGHTON, MI 48116-4353
- **Mailing address phone:** (810) 227-4224
- **Mailing address fax:** (810) 227-4660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 10174 | MI | Yes |
| 122300000X | Dentist | 17224 | MI | — |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 05/22/2013
- **Last updated:** 05/22/2013