Provider Demographics
NPI:1871011593
Name:GRAND OAKS SLEEP SOLUTIONS LLC
Entity Type:Organization
Organization Name:GRAND OAKS SLEEP SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CANNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PHD
Authorized Official - Phone:864-224-0809
Mailing Address - Street 1:3905 LIBERTY HWY
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1229
Mailing Address - Country:US
Mailing Address - Phone:864-224-0809
Mailing Address - Fax:864-224-0811
Practice Address - Street 1:3905 LIBERTY HWY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1229
Practice Address - Country:US
Practice Address - Phone:864-224-0809
Practice Address - Fax:864-224-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4585122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty