Provider Demographics
NPI:1780243683
Name:NORTHWEST BREATHING & WELLNESS CENTER, PLLC
Entity type:Organization
Organization Name:NORTHWEST BREATHING & WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MEZO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-513-8070
Mailing Address - Street 1:1500 W PARNALL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8660
Mailing Address - Country:US
Mailing Address - Phone:517-513-8070
Mailing Address - Fax:517-795-2687
Practice Address - Street 1:1500 W PARNALL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8660
Practice Address - Country:US
Practice Address - Phone:517-513-8070
Practice Address - Fax:517-795-2687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST DENTAL EXCELLENCE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies