Provider Demographics
NPI:1720777519
Name:BETWEEN THE LAKES SLEEP AND AIRWAY CENTER LLC
Entity Type:Organization
Organization Name:BETWEEN THE LAKES SLEEP AND AIRWAY CENTER LLC
Other - Org Name:BETWEEN THE LAKES SLEEP AND AIRWAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:ANNIE
Authorized Official - Last Name:WALLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:920-740-3427
Mailing Address - Street 1:961 RIVER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-4851
Mailing Address - Country:US
Mailing Address - Phone:920-740-3427
Mailing Address - Fax:
Practice Address - Street 1:1250 TECKLA PL
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-9623
Practice Address - Country:US
Practice Address - Phone:920-894-2305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty