Provider Demographics
NPI:1346759370
Name:PROVIDENT SLEEP SOLUTIONS PLLC
Entity Type:Organization
Organization Name:PROVIDENT SLEEP SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-678-8288
Mailing Address - Street 1:40105 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2170
Mailing Address - Country:US
Mailing Address - Phone:248-471-0345
Mailing Address - Fax:248-471-0671
Practice Address - Street 1:40105 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2170
Practice Address - Country:US
Practice Address - Phone:248-471-0345
Practice Address - Fax:248-471-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty