Provider Demographics
NPI:1922485457
Name:NORTHSHORE DENTAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:NORTHSHORE DENTAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MATHESON
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-744-6100
Mailing Address - Street 1:1179 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-2497
Mailing Address - Country:US
Mailing Address - Phone:231-744-6100
Mailing Address - Fax:231-744-6099
Practice Address - Street 1:1179 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-2497
Practice Address - Country:US
Practice Address - Phone:231-744-6100
Practice Address - Fax:231-744-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty