Provider Demographics
NPI:1255878070
Name:DENTAL GROUP NORTHLAND
Entity type:Organization
Organization Name:DENTAL GROUP NORTHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-716-8224
Mailing Address - Street 1:5950 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5950 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5166
Practice Address - Country:US
Practice Address - Phone:816-436-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016018920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty