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Organization

NORTHERN DOOR DENTAL SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS MALCOLM MAYHEW III DDS (DENTIST PRACTICE PRESIDENT OWNER)
(920) 854-5200
Entity
Organization

Contact information

Practice address
10589 S HIGHLAND RD STE 4, SISTER BAY, WI 54234
(920) 854-5200
(920) 854-7601
Mailing address
10589 S HIGHLAND RD STE 4, SISTER BAY, WI 54234
(920) 854-5200
(920) 854-7601

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5002020015
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33368800
WI
Enumeration date
04/03/2007
Last updated
07/30/2008
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