Provider Demographics
NPI:1538347745
Name:NORTH POINT PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:NORTH POINT PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:FISHBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:574-273-8393
Mailing Address - Street 1:3434 E. DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1776
Mailing Address - Country:US
Mailing Address - Phone:574-273-8393
Mailing Address - Fax:574-273-8818
Practice Address - Street 1:3434 E. DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1776
Practice Address - Country:US
Practice Address - Phone:574-273-8393
Practice Address - Fax:574-273-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009640A261QD0000X
IN12009640261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349220AMedicaid