Provider Demographics
NPI:1598274433
Name:NORTHFIELD DENTAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:NORTHFIELD DENTAL MANAGEMENT LLC
Other - Org Name:NORTHFIELD FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-351-1001
Mailing Address - Street 1:8361 E NORTHFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3560
Mailing Address - Country:US
Mailing Address - Phone:303-778-0400
Mailing Address - Fax:303-778-0410
Practice Address - Street 1:8361 E NORTHFIELD BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3560
Practice Address - Country:US
Practice Address - Phone:303-778-0400
Practice Address - Fax:303-778-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental