Provider Demographics
NPI:1487819116
Name:NORTHWEST ENDODONTICS, PC
Entity Type:Organization
Organization Name:NORTHWEST ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-642-4552
Mailing Address - Street 1:18395 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3961
Mailing Address - Country:US
Mailing Address - Phone:503-642-4552
Mailing Address - Fax:503-591-0202
Practice Address - Street 1:18395 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3961
Practice Address - Country:US
Practice Address - Phone:503-642-4552
Practice Address - Fax:503-591-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD74951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty