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General NPI Number Information
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NPI Number | 1306968953
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Entity Type | Organization
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Legal Business Name | NORTHPARK FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1101 13TH ST N STE 1
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City | HUMBOLDT
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State | IA
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Zip | 50548-1129
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Country | US
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Telephone | 515-332-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 13TH ST N STE 1
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City | HUMBOLDT
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State | IA
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Zip | 50548-1129
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Country | US
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Telephone | 515-332-3230
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GRACE SCHOLL
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Credential |
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Telephone | 515-332-3230
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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