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Contact Information

NORTHERN DOOR DENTAL SC
10589 S HIGHLAND RD STE 4
SISTER BAY, WI54234
 Phone: 920-854-5200
 Fax: 920-854-7601
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for NORTHERN DOOR DENTAL SC

NPI # 1013038207
LBN Legal business name NORTHERN DOOR DENTAL SC
Authorized official THOMAS MAYHEW - (DENTIST PRACTICE PRESIDENT OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/03/2007
Last updated 07/30/2008 - About 18 years ago
Identifiers
WI License # 5002020015
WI Medicaid 33368800
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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