Provider Demographics
NPI:1952965949
Name:MINNESOTA SLEEP AND WELLNESS LLC
Entity Type:Organization
Organization Name:MINNESOTA SLEEP AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-380-5486
Mailing Address - Street 1:26626 BROOKS CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1459
Mailing Address - Country:US
Mailing Address - Phone:209-380-5486
Mailing Address - Fax:
Practice Address - Street 1:15600 36TH AVE N STE 270A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3369
Practice Address - Country:US
Practice Address - Phone:763-231-5865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental