Provider Demographics
NPI:1013010982
Name:NORTH POINTE DENTAL GROUP LLP
Entity Type:Organization
Organization Name:NORTH POINTE DENTAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABALLA-WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-581-9394
Mailing Address - Street 1:160 NORTH POINTE BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4134
Mailing Address - Country:US
Mailing Address - Phone:717-581-9394
Mailing Address - Fax:717-581-9308
Practice Address - Street 1:160 NORTH POINTE BLVD
Practice Address - Street 2:STE 205
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4134
Practice Address - Country:US
Practice Address - Phone:717-581-9394
Practice Address - Fax:717-581-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027636L1223P0300X
PADS026723L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty