Provider Demographics
NPI:1720444748
Name:NORTH STREET DENTAL
Entity type:Organization
Organization Name:NORTH STREET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-565-3294
Mailing Address - Street 1:43 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4027
Mailing Address - Country:US
Mailing Address - Phone:614-885-7714
Mailing Address - Fax:614-885-0395
Practice Address - Street 1:43 E NORTH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4027
Practice Address - Country:US
Practice Address - Phone:614-885-7714
Practice Address - Fax:614-885-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH199501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty