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General NPI Number Information
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NPI Number | 1952965949
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Entity Type | Organization
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Legal Business Name | MINNESOTA SLEEP AND WELLNESS LLC
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 15600 36TH AVE N STE 270A
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City | PLYMOUTH
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State | MN
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Zip | 55446-3369
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Country | US
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Telephone | 763-231-5865
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Fax |
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Provider Business Mailing Address
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Address Line | 26626 BROOKS CIR
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City | STEVENSON RANCH
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State | CA
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Zip | 91381-1459
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Country | US
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Telephone | 209-380-5486
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK BALDWIN
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Credential | DDS
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Telephone | 209-380-5486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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