| Northern Dental Group, Pc | |
|
421 Stimpson St. Pellston MI 49769-0275 | |
| (231) 539-8467 | |
| (231) 539-8466 |
| Full Name | Northern Dental Group, Pc |
|---|---|
| Speciality | Dentist |
| Location | 421 Stimpson St., Pellston, Michigan |
| Authorized Official Name and Position | Patricia Ann Soper (TREATMENT COORDINATOR) |
| Authorized Official Contact | 2315398467 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Dental Group, Pc P.o. Box 275 421 Stimpson St. Pellston MI 49769-0275 Ph: (231) 539-8467 | Northern Dental Group, Pc 421 Stimpson St. Pellston MI 49769-0275 Ph: (231) 539-8467 |
| NPI Number | 1629265293 |
|---|---|
| Provider Enumeration Date | 09/27/2007 |
| Last Update Date | 09/27/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629265293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 29010-16726 (Michigan) | Primary |
| 122300000X | Dentist | 29010-17732 (Michigan) | Secondary |