MEDICARE: NORTH STREET DENTAL

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
1	1223G0001X	General Practice Dentistry	19950	OH

General Provider Information

NPI Number	:	1720444748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STREET DENTAL

Provider Business Mailing Address
First Line	:	43 E NORTH ST
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-4027
Country	:	US
Telephone Number	:	614-885-7714
Fax Number	:	614-885-0395

Provider Business Practice Location Address
First Line	:	43 E NORTH ST
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-4027
Country	:	US
Telephone Number	:	614-885-7714
Fax Number	:	614-885-0395

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARAH ELIZABETH CONROY
Credential	:	DDS
Telephone Number	:	614-565-3294

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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Directions to “NORTH STREET DENTAL ” Practice Location

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