Provider Demographics
NPI:1548619414
Name:BAYSHORE SLEEP SOLUTIONS, LLC
Entity type:Organization
Organization Name:BAYSHORE SLEEP SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:REID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-965-0014
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:PACIFIC CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97135-0818
Mailing Address - Country:US
Mailing Address - Phone:503-965-0014
Mailing Address - Fax:503-965-3637
Practice Address - Street 1:38505 BROOTEN RD
Practice Address - Street 2:STE B
Practice Address - City:PACIFIC CITY
Practice Address - State:OR
Practice Address - Zip Code:97135-8049
Practice Address - Country:US
Practice Address - Phone:503-965-0014
Practice Address - Fax:503-965-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty