Provider Demographics
NPI:1043350432
Name:NORTH MOUNTAIN DENTAL GROUP, PC
Entity type:Organization
Organization Name:NORTH MOUNTAIN DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYMOUR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-949-0277
Mailing Address - Street 1:3301 N MILLER RD
Mailing Address - Street 2:STE 135
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6431
Mailing Address - Country:US
Mailing Address - Phone:480-949-0277
Mailing Address - Fax:
Practice Address - Street 1:3301 N MILLER RD
Practice Address - Street 2:STE 135
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6431
Practice Address - Country:US
Practice Address - Phone:480-949-0277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty