Provider Demographics
NPI:1275574675
Name:NORTHFIELD DENTAL GROUP
Entity Type:Organization
Organization Name:NORTHFIELD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-485-3051
Mailing Address - Street 1:391 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05663-5745
Mailing Address - Country:US
Mailing Address - Phone:802-485-3051
Mailing Address - Fax:802-485-8384
Practice Address - Street 1:391 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5745
Practice Address - Country:US
Practice Address - Phone:802-485-3051
Practice Address - Fax:802-485-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty