Northcreek Dental PC – General Practice Dentistry

Key facts

NPI: 1669917308
Entity type: Organization (NPI type 2)
Primary specialty: General Practice Dentistry 1223G0001X
Legal business name: NORTHCREEK DENTAL PC
Practice address: 19 Wiley Ave
Lidgewood, ND 58053
Phone: (701) 538-4583
Fax: (701) 538-4560
NPI assigned: Jan 5, 2017
Organization subpart: No

Authorized official

Name: Dr. Mark Schaffer, DDS
Title: Ower/Dentish
Phone: (701) 242-7140

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Northcreek Dental PC Endodontics · Fargo, ND · NPI 1467524496

NPD tax ID
Northcreek Dental, PC Dental Clinic/Center · Hankinson, ND · NPI 1902203854

NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

James D Marotzke, DDS General Practice Dentistry · Lidgerwood, ND · NPI 1376692756

NPD (past) GENERAL PRACTICE

National Provider Directory

Tax ID family: Hankinson Dental (3 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry Group: 193400000X SINGLE SPECIALTY GROUP	1223G0001X		ND	Yes

Addresses

Primary practice location

19 Wiley Ave
Lidgewood, ND 58053

Mailing address

17060 Hwy 46
Horace, ND 58047

Other names

Lidgerwood Dental Doing business as

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.