Provider Demographics
NPI:1639885445
Name:NORTH POINTE DENTAL
Entity Type:Organization
Organization Name:NORTH POINTE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-219-9161
Mailing Address - Street 1:1261 S 820 E STE 100
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3875
Mailing Address - Country:US
Mailing Address - Phone:801-805-1934
Mailing Address - Fax:801-805-1930
Practice Address - Street 1:10290 N NORTH COUNTY BLVD # 101
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8973
Practice Address - Country:US
Practice Address - Phone:801-805-1934
Practice Address - Fax:801-805-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7002323-9923OtherSTATE OF UTAH DEPARTMENT OF COMMERCE