MEDICARE: NORTHWOODS DENTAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1184334377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS DENTAL, LLC

Provider Business Mailing Address
First Line	:	7327 N WABASH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1219
Country	:	US
Telephone Number	:	402-301-1197
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 SE 36TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1862
Country	:	US
Telephone Number	:	503-235-7181
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DDS
Name	:	DR. MICHELLE MARGARET FALBO
Credential	:	DDS
Telephone Number	:	651-470-7304

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	11/29/2022

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