Provider Demographics
NPI:1669125415
Name:NORTHPARK SRGS PLLC
Entity type:Organization
Organization Name:NORTHPARK SRGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABTAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-493-1216
Mailing Address - Street 1:10343 FEDERAL BLVD UNIT O-N
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-7402
Mailing Address - Country:US
Mailing Address - Phone:214-493-1216
Mailing Address - Fax:
Practice Address - Street 1:10343 FEDERAL BLVD UNIT O-N
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80260-7402
Practice Address - Country:US
Practice Address - Phone:214-493-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty