Healthcare Provider Details

I. General information

NPI: 1013010982
Provider Name (Legal Business Name): NORTH POINTE DENTAL GROUP LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NORTH POINTE BLVD STE 205
LANCASTER PA
17601-4134
US

IV. Provider business mailing address

160 NORTH POINTE BLVD STE 205
LANCASTER PA
17601-4134
US

V. Phone/Fax

Practice location:
  • Phone: 717-581-9394
  • Fax: 717-581-9308
Mailing address:
  • Phone: 717-581-9394
  • Fax: 717-581-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS026723L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS027636L
License Number StatePA

VIII. Authorized Official

Name: AMY CHABALLA-WILDE
Title or Position: PARTNER
Credential: DMD
Phone: 717-581-9394