MEDICARE: SLEEP WELL SOUTHEAST TEXAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1356911440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLEEP WELL SOUTHEAST TEXAS LLC

Provider Business Mailing Address
First Line	:	3033 MARINA BAY DR STE 230
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3982
Country	:	US
Telephone Number	:	281-222-9924
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 MARINA BAY DR STE 230
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3982
Country	:	US
Telephone Number	:	281-222-9924
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK TIEKEN
Credential	:	DDS
Telephone Number	:	281-222-9924

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	01/21/2025

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Directions to “SLEEP WELL SOUTHEAST TEXAS LLC ” Practice Location

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