Provider Demographics
NPI:1194843789
Name:NORTH COUNTRY DENTAL CARE, P. C.
Entity Type:Organization
Organization Name:NORTH COUNTRY DENTAL CARE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAND
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:631-584-5605
Mailing Address - Street 1:436 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1706
Mailing Address - Country:US
Mailing Address - Phone:631-584-5605
Mailing Address - Fax:631-862-1186
Practice Address - Street 1:436 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1706
Practice Address - Country:US
Practice Address - Phone:631-584-5605
Practice Address - Fax:631-862-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34846261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental