Provider Demographics
NPI:1073735478
Name:NORTHWOOD DENTAL LLC
Entity Type:Organization
Organization Name:NORTHWOOD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-797-5161
Mailing Address - Street 1:3023 EASTLAND BLVD
Mailing Address - Street 2:BLDG H, SUITE 112
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4106
Mailing Address - Country:US
Mailing Address - Phone:727-797-5161
Mailing Address - Fax:727-797-5121
Practice Address - Street 1:3023 EASTLAND BLVD
Practice Address - Street 2:BLDG H, SUITE 112
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4106
Practice Address - Country:US
Practice Address - Phone:727-797-5161
Practice Address - Fax:727-797-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty