Provider Demographics
NPI:1427762533
Name:SLEEP HEALTH WISCONSIN LLC
Entity type:Organization
Organization Name:SLEEP HEALTH WISCONSIN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-573-3546
Mailing Address - Street 1:301 N 17TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4225
Mailing Address - Country:US
Mailing Address - Phone:715-573-3546
Mailing Address - Fax:
Practice Address - Street 1:1052 BEL AIRE CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5015
Practice Address - Country:US
Practice Address - Phone:920-499-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY PARK SMILES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No122300000XDental ProvidersDentistGroup - Multi-Specialty