Healthcare Provider Details

I. General information

NPI: 1467240531
Provider Name (Legal Business Name): NORTHERN LIGHTS SLEEP SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 COPPER VW STE 200
TRAVERSE CITY MI
49684-7041
US

IV. Provider business mailing address

4020 COPPER VW STE 200
TRAVERSE CITY MI
49684-7041
US

V. Phone/Fax

Practice location:
  • Phone: 231-828-2594
  • Fax:
Mailing address:
  • Phone: 231-828-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREK JAMES RICE
Title or Position: OWNER
Credential: DDS
Phone: 231-828-2594