Organization
NORTHERN DENTAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA ANN SOPER (TREATMENT COORDINATOR)
(231) 539-8467
Entity
Organization
Contact information
Practice address
421 STIMPSON ST., PELLSTON, MI 49769-0275
(231) 539-8467
(231) 539-8466
Mailing address
P.O. BOX 275, 421 STIMPSON ST., PELLSTON, MI 49769-0275
(231) 539-8467
(231) 539-8466
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29010-16726
MI
122300000X
Dentist
29010-17732
MI
Other
Enumeration date
09/27/2007
Last updated
09/27/2007
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