Northstar Family Dentistry Pllc | |
64845 Van Dyke Rd Ste 3 Washington MI 48095-2836 | |
(586) 752-6596 | |
(586) 752-5471 |
Full Name | Northstar Family Dentistry Pllc |
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Speciality | Dentist |
Location | 64845 Van Dyke Rd Ste 3, Washington, Michigan |
Authorized Official Name and Position | Faith Maryam Aboona (PROVIDER/OWNER) |
Authorized Official Contact | 5867526596 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Northstar Family Dentistry Pllc 64845 Van Dyke Rd Ste 3 Washington MI 48095-2836 Ph: (586) 752-6596 | Northstar Family Dentistry Pllc 64845 Van Dyke Rd Ste 3 Washington MI 48095-2836 Ph: (586) 752-6596 |
NPI Number | 1033659503 |
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Provider Enumeration Date | 03/03/2017 |
Last Update Date | 04/23/2020 |
Medicare PECOS PAC ID | 6507296076 |
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Medicare Enrollment ID | O20200423002961 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033659503 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
Provider Name | Faith Aboona |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1336404979 PECOS PAC ID: 5597195065 Enrollment ID: I20200423003066 |
Provider Name | Gabrielle Malette |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1235782616 PECOS PAC ID: 5294132072 Enrollment ID: I20210921002510 |
Provider Name | Taryn Gladwish |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1427678283 PECOS PAC ID: 6709271752 Enrollment ID: I20220310000382 |
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