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General NPI Number Information
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NPI Number | 1194843789
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY DENTAL CARE, P. C.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 436 ROUTE 25A
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City | SAINT JAMES
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State | NY
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Zip | 11780-1706
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Country | US
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Telephone | 631-584-5605
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Fax | 631-862-1186
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Provider Business Mailing Address
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Address Line | 436 ROUTE 25A
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City | SAINT JAMES
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State | NY
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Zip | 11780-1706
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Country | US
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Telephone | 631-584-5605
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Fax | 631-862-1186
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J MAND
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Credential | D. D. S.
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Telephone | 631-584-5605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 34846
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License Number State | NY
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