Provider Demographics
NPI:1003903741
Name:NORTHWAY AND HALL ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:NORTHWAY AND HALL ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-946-0070
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty