Provider Demographics
NPI:1336507136
Name:NORTH COUNTRY DENTAL SEVICES
Entity Type:Organization
Organization Name:NORTH COUNTRY DENTAL SEVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTRIX
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-212-7018
Mailing Address - Street 1:22 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1229
Mailing Address - Country:US
Mailing Address - Phone:315-265-9320
Mailing Address - Fax:315-265-5903
Practice Address - Street 1:22 DEPOT ST STE 14
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1140
Practice Address - Country:US
Practice Address - Phone:315-265-9320
Practice Address - Fax:315-265-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty