Provider Demographics
NPI:1629286273
Name:NORTHWEST ORAL & MAXILLOFACIAL SURGEONS, LLC
Entity Type:Organization
Organization Name:NORTHWEST ORAL & MAXILLOFACIAL SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-665-7882
Mailing Address - Street 1:24850 SE STARK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8316
Mailing Address - Country:US
Mailing Address - Phone:503-665-7882
Mailing Address - Fax:503-665-6983
Practice Address - Street 1:24850 SE STARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8316
Practice Address - Country:US
Practice Address - Phone:503-665-7882
Practice Address - Fax:503-665-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD42831223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty