Provider Demographics
NPI:1548873276
Name:NORTH COUNTRY DENTAL
Entity type:Organization
Organization Name:NORTH COUNTRY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-879-5271
Mailing Address - Street 1:716 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2406
Mailing Address - Country:US
Mailing Address - Phone:218-879-5271
Mailing Address - Fax:218-878-7990
Practice Address - Street 1:716 14TH ST
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2406
Practice Address - Country:US
Practice Address - Phone:218-879-5271
Practice Address - Fax:218-878-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty