Provider Demographics
NPI:1033659503
Name:NORTHSTAR FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:NORTHSTAR FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:MARYAM
Authorized Official - Last Name:ABOONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-752-6596
Mailing Address - Street 1:64845 VAN DYKE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2836
Mailing Address - Country:US
Mailing Address - Phone:586-752-6596
Mailing Address - Fax:586-752-5471
Practice Address - Street 1:64845 VAN DYKE RD STE 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2836
Practice Address - Country:US
Practice Address - Phone:586-752-6596
Practice Address - Fax:586-752-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty