Provider Demographics
NPI:1235207887
Name:NORTH, AMY L
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:NORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60431
Mailing Address - Country:US
Mailing Address - Phone:815-744-3122
Mailing Address - Fax:
Practice Address - Street 1:406 W BOUGHTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-759-8940
Practice Address - Fax:630-759-9392
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist