Provider Demographics
NPI:1841571973
Name:SLEEP WELL DENTAL, LLC
Entity type:Organization
Organization Name:SLEEP WELL DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:STELLPFLUG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-887-8079
Mailing Address - Street 1:P.O. BOX 675
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2450
Mailing Address - Country:US
Mailing Address - Phone:920-887-8079
Mailing Address - Fax:920-887-1203
Practice Address - Street 1:207 S. UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2450
Practice Address - Country:US
Practice Address - Phone:920-887-8079
Practice Address - Fax:920-887-1203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP WELL DENTAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1352G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty