Provider Demographics
NPI:1659788842
Name:NORTHWEST DENTAL PARTNERS, LLC
Entity Type:Organization
Organization Name:NORTHWEST DENTAL PARTNERS, LLC
Other - Org Name:HILLSBORO DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-648-6671
Mailing Address - Street 1:324 SE 9TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4247
Mailing Address - Country:US
Mailing Address - Phone:503-648-6671
Mailing Address - Fax:503-693-1143
Practice Address - Street 1:324 SE 9TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4247
Practice Address - Country:US
Practice Address - Phone:503-648-6671
Practice Address - Fax:503-693-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD100691223G0001X
ORD100891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty