# NORTHERN MICHIGAN FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gaylord Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215100987
- **Authorized official:** NICOLE KOENIG (OFFICE MANAGER)
- **Authorized official phone:** (989) 732-4199

## Contact information

- **Practice address:** 1507 S OTSEGO AVE STE A, GAYLORD, MI 49735-9524
- **Practice address phone:** (989) 732-4199
- **Practice address fax:** (989) 731-6762
- **Mailing address:** PO BOX 1725, GAYLORD, MI 49734-5725
- **Mailing address phone:** (989) 732-4199
- **Mailing address fax:** (989) 731-6762

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 16080 | MI | Yes |

## Other

- **Enumeration date:** 04/02/2008
- **Last updated:** 03/19/2018