Provider Demographics
NPI:1598918369
Name:NORTHRUP, KARL K JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:K
Last Name:NORTHRUP
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 C ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1841
Mailing Address - Country:US
Mailing Address - Phone:509-754-4226
Mailing Address - Fax:
Practice Address - Street 1:3143 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4815
Practice Address - Country:US
Practice Address - Phone:509-389-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600538711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice