Provider Demographics
NPI:1831500958
Name:MICHIGAN SLEEP NETWORK PC
Entity Type:Organization
Organization Name:MICHIGAN SLEEP NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-784-0274
Mailing Address - Street 1:555 MIDTOWNE NE
Mailing Address - Street 2:SUITE 104-B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5713
Mailing Address - Country:US
Mailing Address - Phone:616-784-0274
Mailing Address - Fax:616-784-4468
Practice Address - Street 1:555 MIDTOWNE NE
Practice Address - Street 2:SUITE 104-B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5713
Practice Address - Country:US
Practice Address - Phone:616-784-0274
Practice Address - Fax:616-784-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6880120001Medicare PIN