Healthcare Provider Details

I. General information

NPI: 1871011593
Provider Name (Legal Business Name): GRAND OAKS SLEEP SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 LIBERTY HWY
ANDERSON SC
29621-1229
US

IV. Provider business mailing address

3905 LIBERTY HWY
ANDERSON SC
29621-1229
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-0809
  • Fax: 864-224-0811
Mailing address:
  • Phone: 864-224-0809
  • Fax: 864-224-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4585
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIELLE F CANNICK
Title or Position: OWNER/DENTIST
Credential: DMD, PHD
Phone: 864-224-0809