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NPI Code Detail

MEDICARE: NORTHERN DENTAL PARTNERS AND ASSOCIATES PLLC

MEDICARE: NORTHERN DENTAL PARTNERS AND ASSOCIATES PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1274L7MI27SLOTHERMNBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396497434
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN DENTAL PARTNERS AND ASSOCIATES PLLC
Provider Business Mailing Address
First Line : 1121 SE 4TH AVE
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-3956
Country : US
Telephone Number : 218-326-3437
Fax Number : 218-327-1211
Provider Business Practice Location Address
First Line : 1121 SE 4TH AVE
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-3956
Country : US
Telephone Number : 218-326-3437
Fax Number : 218-327-1211
Authorized Official
Title or Position : DENTIST/PARTNER
Name : DR. PETER JOHN MISKOVICH
Credential : DDS
Telephone Number : 218-326-3437
Provider Enumeration Date : 01/20/2022
Last Update Date : 01/20/2022

Similar Medicare Providers

1063079242 — ANDREW STUART KUEHN DDS
Practice Location Address:
1121 SE 4TH AVE
GRAND RAPIDS, MN
55744-3956
Practice Phone: 218-326-3437
Practice Fax:
1891654612 — 97 SMILES OF GRAND RAPIDS
Practice Location Address:
2300 3 MILE RD NE
GRAND RAPIDS, MI
49505-3956
Practice Phone: 616-365-8699
Practice Fax:
1174726533 — MARK WILLIAM POSTHUMUS DDS
Practice Location Address:
2300 3 MILE RD NE
GRAND RAPIDS, MI
49505-3956
Practice Phone: 616-363-3712
Practice Fax:
1467803080 — DR. DAVID MICHAEL POSTHUMUS DDS
Practice Location Address:
2300 3 MILE RD NE
GRAND RAPIDS, MI
49505-3956
Practice Phone: 616-363-3712
Practice Fax:
1164068136 — POSTHUMUS FAMILY DENTISTRY, PC
Practice Location Address:
2300 3 MILE RD NE
GRAND RAPIDS, MI
49505-3956
Practice Phone: 616-363-3712
Practice Fax: 616-363-4285
1427790526 — SHARON L BUROCCHI DDS PLC
Practice Location Address:
2300 3 MILE RD NE
GRAND RAPIDS, MI
49505-3956
Practice Phone: 616-365-8699
Practice Fax: 616-365-8795

Directions to “NORTHERN DENTAL PARTNERS AND ASSOCIATES PLLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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