Provider Demographics
NPI:1083856546
Name:NORTH WOODS DENTAL, PA
Entity Type:Organization
Organization Name:NORTH WOODS DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BARTLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-237-5555
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-0016
Mailing Address - Country:US
Mailing Address - Phone:603-237-5555
Mailing Address - Fax:
Practice Address - Street 1:75 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3600
Practice Address - Country:US
Practice Address - Phone:603-237-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty