Healthcare Provider Details

I. General information

NPI: 1962053744
Provider Name (Legal Business Name): GR SOUND SLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 01/17/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 WILSON AVE SW SUITE #8
GRAND RAPIDS MI
49518-7889
US

IV. Provider business mailing address

4475 WILSON AVE SW SUITE #8
GRAND RAPIDS MI
49518
US

V. Phone/Fax

Practice location:
  • Phone: 616-498-1992
  • Fax:
Mailing address:
  • Phone: 616-498-1992
  • Fax: 616-656-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEREMY D HESS
Title or Position: OWNER
Credential: DDS
Phone: 616-871-9604