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General NPI Number Information
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NPI Number | 1003991464
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Entity Type | Organization
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Legal Business Name | NORTHVIEW DENTAL ASSOCS
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1779 WILLOW RD
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City | NORTHFIELD
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State | IL
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Zip | 60093
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Country | US
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Telephone | 847-446-9250
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Fax | 847-446-9270
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Provider Business Mailing Address
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Address Line | 1779 WILLOW RD
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City | NORTHFIELD
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State | IL
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Zip | 60093
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Country | US
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Telephone | 847-446-9250
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Fax | 847-446-9270
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Authorized Official
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Title or Position | PRESIDENT DENTIST
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Name | JEFFREY M BEUTTELL
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Credential |
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Telephone | 847-446-9250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19A14015
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License Number State | IL
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