Provider Demographics
NPI:1578947545
Name:NORTHWEST IMAGING LLC
Entity Type:Organization
Organization Name:NORTHWEST IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:OBENCHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-740-4961
Mailing Address - Street 1:1020 ANDERSON DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1055
Mailing Address - Country:US
Mailing Address - Phone:360-612-3034
Mailing Address - Fax:360-532-9977
Practice Address - Street 1:1020 ANDERSON DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-612-3034
Practice Address - Fax:360-532-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-19
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE6010233381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty