Provider Demographics
NPI:1093263543
Name:SLEEP WELL AZ PLLC
Entity Type:Organization
Organization Name:SLEEP WELL AZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-975-4965
Mailing Address - Street 1:10195 N ORACLE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-8749
Mailing Address - Country:US
Mailing Address - Phone:520-219-7004
Mailing Address - Fax:520-219-9811
Practice Address - Street 1:10195 N ORACLE RD
Practice Address - Street 2:STE 111
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-8749
Practice Address - Country:US
Practice Address - Phone:520-219-7004
Practice Address - Fax:520-219-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8922332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies