1366618852 NPI number — NORTHLAND DEPENDENCY SERVICES, LLC

Table of content: CHRISTOPHER JOHN GREEN DDS (NPI 1518006808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366618852 NPI number — NORTHLAND DEPENDENCY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHLAND DEPENDENCY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366618852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 S GALLATIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64068-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-781-8999
Provider Business Mailing Address Fax Number:
816-792-2883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 S GALLATIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-781-8999
Provider Business Practice Location Address Fax Number:
816-792-2883
Provider Enumeration Date:
05/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLOSS
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
816-781-8999

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  1264-8522 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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