Provider Demographics
NPI:1184334377
Name:NORTHWOODS DENTAL, LLC
Entity type:Organization
Organization Name:NORTHWOODS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:FALBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-470-7304
Mailing Address - Street 1:7327 N WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-1219
Mailing Address - Country:US
Mailing Address - Phone:402-301-1197
Mailing Address - Fax:
Practice Address - Street 1:3505 SE 36TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1862
Practice Address - Country:US
Practice Address - Phone:503-235-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty