MEDICARE: BAYSHORE SLEEP SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6118	OR

General Provider Information

NPI Number	:	1548619414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE SLEEP SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 818
Second Line	:
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-0818
Country	:	US
Telephone Number	:	503-965-0014
Fax Number	:	503-965-3637

Provider Business Practice Location Address
First Line	:	38505 BROOTEN RD
Second Line	:	STE B
City	:	PACIFIC CITY
State	:	OR
Zip	:	97135-8049
Country	:	US
Telephone Number	:	503-965-0014
Fax Number	:	503-965-3637

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GRANT REID WILLIAMS
Credential	:	DMD
Telephone Number	:	503-965-0014

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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