Provider Demographics
NPI:1982933396
Name:UP NORTH DENTAL
Entity Type:Organization
Organization Name:UP NORTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SPECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-885-9921
Mailing Address - Street 1:210 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1130
Mailing Address - Country:US
Mailing Address - Phone:218-885-9921
Mailing Address - Fax:218-885-9924
Practice Address - Street 1:210 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1130
Practice Address - Country:US
Practice Address - Phone:218-885-9921
Practice Address - Fax:218-885-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty