Provider Demographics
NPI:1801983531
Name:NORTHWAY, WILLIAM M (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:NORTHWAY
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12776 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5451
Mailing Address - Country:US
Mailing Address - Phone:231-946-0070
Mailing Address - Fax:231-946-6026
Practice Address - Street 1:12776 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5451
Practice Address - Country:US
Practice Address - Phone:231-946-0070
Practice Address - Fax:231-946-6026
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4852715Medicaid