Healthcare Provider Details

I. General information

NPI: 1770357485
Provider Name (Legal Business Name): THE SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E MAIN ST
WEISER ID
83672-2225
US

IV. Provider business mailing address

1145 PIONEER RD
WEISER ID
83672-1163
US

V. Phone/Fax

Practice location:
  • Phone: 986-942-9105
  • Fax: 855-811-3293
Mailing address:
  • Phone: 206-818-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HOLM
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 206-818-0942