Provider Demographics
NPI:1033574348
Name:NORTHWOODS DENTAL LLC
Entity Type:Organization
Organization Name:NORTHWOODS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMITROULA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUZOUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-474-8588
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0411
Mailing Address - Country:US
Mailing Address - Phone:207-474-8588
Mailing Address - Fax:207-474-9745
Practice Address - Street 1:327 NORTH AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976
Practice Address - Country:US
Practice Address - Phone:207-474-8588
Practice Address - Fax:207-474-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty