Provider Demographics
NPI:1386304574
Name:NORTHWOODS DENTISTRY WOODRUFF LLC
Entity type:Organization
Organization Name:NORTHWOODS DENTISTRY WOODRUFF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-428-2421
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:PRENTICE
Mailing Address - State:WI
Mailing Address - Zip Code:54556-0027
Mailing Address - Country:US
Mailing Address - Phone:715-428-2421
Mailing Address - Fax:715-428-2431
Practice Address - Street 1:110 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9196
Practice Address - Country:US
Practice Address - Phone:715-356-6339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental