Provider Demographics
NPI:1558195255
Name:SLEEP DDS LLC
Entity type:Organization
Organization Name:SLEEP DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-390-0110
Mailing Address - Street 1:345 N 2ND E STE 3
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1603
Mailing Address - Country:US
Mailing Address - Phone:208-356-8759
Mailing Address - Fax:
Practice Address - Street 1:345 N 2ND E STE 3
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1603
Practice Address - Country:US
Practice Address - Phone:208-356-8759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty