Provider Demographics
NPI:1003991464
Name:NORTHVIEW DENTAL ASSOCS
Entity Type:Organization
Organization Name:NORTHVIEW DENTAL ASSOCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEUTTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-446-9250
Mailing Address - Street 1:1779 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-446-9250
Mailing Address - Fax:847-446-9270
Practice Address - Street 1:1779 WILLOW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-446-9250
Practice Address - Fax:847-446-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty