Provider Demographics
NPI:1548436736
Name:NORTH SHORE PERIODONTICS AND DENTAL IMPLANTS
Entity type:Organization
Organization Name:NORTH SHORE PERIODONTICS AND DENTAL IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMALFITANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-775-6321
Mailing Address - Street 1:8865 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8424
Mailing Address - Country:US
Mailing Address - Phone:231-775-6321
Mailing Address - Fax:231-775-0552
Practice Address - Street 1:8865 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8424
Practice Address - Country:US
Practice Address - Phone:231-775-6321
Practice Address - Fax:231-775-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI155811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty