Healthcare Provider Details

I. General information

NPI: 1033659503
Provider Name (Legal Business Name): NORTHSTAR FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64845 VAN DYKE RD STE 3
WASHINGTON MI
48095-2836
US

IV. Provider business mailing address

64845 VAN DYKE RD STE 3
WASHINGTON MI
48095-2836
US

V. Phone/Fax

Practice location:
  • Phone: 586-752-6596
  • Fax: 586-752-5471
Mailing address:
  • Phone: 586-752-6596
  • Fax: 586-752-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. FAITH MARYAM ABOONA
Title or Position: PROVIDER/OWNER
Credential: DDS
Phone: 586-752-6596