# NORTHERN DENTAL GROUP, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629265293
- **Authorized official:** MRS. PATRICIA ANN SOPER (TREATMENT COORDINATOR)
- **Authorized official phone:** (231) 539-8467

## Contact information

- **Practice address:** 421 STIMPSON ST., PELLSTON, MI 49769-0275
- **Practice address phone:** (231) 539-8467
- **Practice address fax:** (231) 539-8466
- **Mailing address:** P.O. BOX 275, 421 STIMPSON ST., PELLSTON, MI 49769-0275
- **Mailing address phone:** (231) 539-8467
- **Mailing address fax:** (231) 539-8466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 29010-16726 | MI | Yes |
| 122300000X | Dentist | 29010-17732 | MI | — |

## Other

- **Enumeration date:** 09/27/2007
- **Last updated:** 09/27/2007