Provider Demographics
NPI:1679553093
Name:NORTHSTAR DENTAL GRP
Entity type:Organization
Organization Name:NORTHSTAR DENTAL GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEHLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-997-1557
Mailing Address - Street 1:5760 GRAND MARKET DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913
Mailing Address - Country:US
Mailing Address - Phone:920-997-1557
Mailing Address - Fax:920-997-0688
Practice Address - Street 1:5760 GRANDE MARKET DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-997-1557
Practice Address - Fax:920-997-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty