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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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