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Organization
NORTHERN PERIODONTICS & IMPLANT DENTISTRY, P.C.
Active
Organization
NORTHERN PERIODONTICS & IMPLANT DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAUGHN A MCGRAW D.D.S., M.S. (PRESIDENT)
(231) 347-2518
Entity
Organization
Contact information
Practice address
2115 M 119, PETOSKEY, MI 49770-8914
(231) 347-2518
(231) 347-8530
Mailing address
2115 M 119, PETOSKEY, MI 49770-8914
(231) 347-2518
(231) 347-8530
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2901010159
MI
1223P0300X
Periodontics
2901014067
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255443321
—
MI
05
—
1750493896
—
MI
Enumeration date
10/15/2012
Last updated
10/15/2012
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