Provider Demographics
NPI:1003966102
Name:NORTHWOOD FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:NORTHWOOD FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-773-7979
Mailing Address - Street 1:1001 N MAIN ST
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-1016
Mailing Address - Country:US
Mailing Address - Phone:574-773-7979
Mailing Address - Fax:574-773-7292
Practice Address - Street 1:1001 N MAIN ST
Practice Address - Street 2:SUITE TWO
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-1016
Practice Address - Country:US
Practice Address - Phone:574-773-7979
Practice Address - Fax:574-773-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007757B1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty