Provider Demographics
NPI:1114467974
Name:NORTERRA DENTAL CARE
Entity Type:Organization
Organization Name:NORTERRA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEONG-YUP
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-780-3333
Mailing Address - Street 1:2370 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE 1073
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8507
Mailing Address - Country:US
Mailing Address - Phone:623-780-3333
Mailing Address - Fax:623-582-1074
Practice Address - Street 1:2370 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE 1073
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8507
Practice Address - Country:US
Practice Address - Phone:623-780-3333
Practice Address - Fax:623-582-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty