Provider Demographics
NPI:1356911440
Name:SLEEP WELL SOUTHEAST TEXAS LLC
Entity type:Organization
Organization Name:SLEEP WELL SOUTHEAST TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-222-9924
Mailing Address - Street 1:3033 MARINA BAY DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3982
Mailing Address - Country:US
Mailing Address - Phone:281-222-9924
Mailing Address - Fax:
Practice Address - Street 1:3033 MARINA BAY DR STE 230
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3982
Practice Address - Country:US
Practice Address - Phone:281-222-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty