Provider Demographics
NPI:1407625320
Name:NORTHWEST DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:NORTHWEST DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE LAISON
Authorized Official - Prefix:MS
Authorized Official - First Name:MEAGAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-306-1514
Mailing Address - Street 1:417 SW SEDGWICK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6449
Mailing Address - Country:US
Mailing Address - Phone:253-306-1514
Mailing Address - Fax:
Practice Address - Street 1:417 SW SEDGWICK RD STE 101
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6449
Practice Address - Country:US
Practice Address - Phone:360-329-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty