Northern Dental Group, PC

Primary specialty

DentistTaxonomy code 122300000X

License

29010-16726 Issued in MI

Legal business name

NORTHERN DENTAL GROUP, PC

Practice address

421 Stimpson St.
Pellston, MI 49769-0275

Phone

(231) 539-8467

Fax

(231) 539-8466

NPI assigned

Sep 27, 2007

Last updated

Sep 27, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Patricia Ann Soper

Title

Treatment Coordinator

Phone

(231) 539-8467

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190851200000",
    "number": "1629265293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 275",
            "address_2": "421 STIMPSON ST.",
            "city": "PELLSTON",
            "state": "MI",
            "postal_code": "497690275",
            "telephone_number": "231-539-8467",
            "fax_number": "231-539-8466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 STIMPSON ST.",
            "city": "PELLSTON",
            "state": "MI",
            "postal_code": "497690275",
            "telephone_number": "231-539-8467",
            "fax_number": "231-539-8466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-09-27",
        "status": "A",
        "authorized_official_last_name": "SOPER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "TREATMENT COORDINATOR",
        "authorized_official_telephone_number": "231-539-8467",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "29010-16726",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MI",
            "license": "29010-17732",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alcona Citizens for Health, Inc (Alcona Health Center Pellston Services)
• Stephanie Anderson, D.C
• David B Chauvin, DO
• Ashley Elizabeth Cook, M.D.
• Barbara Jean Laughbaum, L.P.C.
• Mary Kathryn Ransford, MS, LLPC
• Rachelle Rife, MA, LPC
• Anne Regina Taylor, LMSW
• Alissa Ann Vieau
• Chase Woods

• Dentist in Pellston, MI
• Providers in Pellston, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.