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General NPI Number Information
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NPI Number | 1659880961
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Entity Type | Organization
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Legal Business Name | NORTHSHORE DENTAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 1179 WHITEHALL ROAD SUITE A
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City | MUSKEGON
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State | MI
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Zip | 49445
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Country | US
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Telephone | 231-744-6100
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Fax | 231-744-6099
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Provider Business Mailing Address
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Address Line | 1179 WHITEHALL ROAD SUITE A
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City | MUSKEGON
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State | MI
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Zip | 49445
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Country | US
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Telephone | 231-744-6100
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Fax | 231-744-6099
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Authorized Official
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Title or Position | BUSINESS ASSISTANT
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Name | CARMEN PAYNE
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Credential |
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Telephone | 231-744-6100
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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 |
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License Number State |
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