=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023470473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEPCLEARNOW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2016
-----------------------------------------------------
Last Update Date | 12/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6070 N PORT WASHINGTON RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-4524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-962-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6070 N PORT WASHINGTON RD
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-4524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-436-4297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL M SANDVICK
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 414-436-4297
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2726-15
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------