Provider Demographics
NPI:1881968477
Name:SLEEP ENHANCEMENT CENTER LLC
Entity type:Organization
Organization Name:SLEEP ENHANCEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLEEP MEDICINE DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-437-8009
Mailing Address - Street 1:800 1ST AVE SW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2507
Mailing Address - Country:US
Mailing Address - Phone:507-437-8009
Mailing Address - Fax:
Practice Address - Street 1:800 1ST AVE SW
Practice Address - Street 2:SUITE 111
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2507
Practice Address - Country:US
Practice Address - Phone:507-437-8009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND-9111332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment