Provider Demographics
NPI:1962509117
Name:NORWAY DENTAL PC
Entity Type:Organization
Organization Name:NORWAY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:FORNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-563-8010
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:800 S CASE ST
Mailing Address - City:NORWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49870
Mailing Address - Country:US
Mailing Address - Phone:906-563-8010
Mailing Address - Fax:906-563-5862
Practice Address - Street 1:800 S CASE ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:MI
Practice Address - Zip Code:49870
Practice Address - Country:US
Practice Address - Phone:906-563-8010
Practice Address - Fax:906-563-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty