Healthcare Provider Details

I. General information

NPI: 1831500958
Provider Name (Legal Business Name): MICHIGAN SLEEP NETWORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MIDTOWNE NE SUITE 104-B
GRAND RAPIDS MI
49503-5713
US

IV. Provider business mailing address

555 MIDTOWNE NE SUITE 104-B
GRAND RAPIDS MI
49503-5713
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-0274
  • Fax: 616-784-4468
Mailing address:
  • Phone: 616-784-0274
  • Fax: 616-784-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11372
License Number StateMI

VIII. Authorized Official

Name: DR. DANIEL J BURTON
Title or Position: C.O.O
Credential: DDS
Phone: 616-784-0274