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General NPI Number Information
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NPI Number | 1215083183
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Entity Type | Organization
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Legal Business Name | NORTHWOODS DENTAL
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15600 36TH AVE N SUITE 270
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City | PLYMOUTH
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State | MN
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Zip | 55446-3369
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Country | US
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Telephone | 763-557-0911
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Fax | 763-557-5157
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Provider Business Mailing Address
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Address Line | 15600 36TH AVE N SUITE 270
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City | PLYMOUTH
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State | MN
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Zip | 55446-3369
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Country | US
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Telephone | 763-557-0911
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Fax | 763-557-5157
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PAMELA J KENT
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Credential |
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Telephone | 763-557-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10011
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License Number State | MN
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