Provider Demographics
NPI:1912635400
Name:NORTHERN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:NORTHERN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:TIEPPO
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-275-1919
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:ROSCOMMON
Mailing Address - State:MI
Mailing Address - Zip Code:48653-0920
Mailing Address - Country:US
Mailing Address - Phone:989-275-1919
Mailing Address - Fax:989-275-1619
Practice Address - Street 1:100 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:ROSCOMMON
Practice Address - State:MI
Practice Address - Zip Code:48653-9218
Practice Address - Country:US
Practice Address - Phone:989-275-1919
Practice Address - Fax:989-275-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental