Provider Demographics
NPI:1396180253
Name:NORTHVIEW DENTAL
Entity Type:Organization
Organization Name:NORTHVIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASICZNYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-818-7777
Mailing Address - Street 1:210 E 91ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1570
Mailing Address - Country:US
Mailing Address - Phone:317-818-7777
Mailing Address - Fax:
Practice Address - Street 1:210 E 91ST ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1570
Practice Address - Country:US
Practice Address - Phone:317-818-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011425A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty