Provider Demographics
NPI:1174968507
Name:NORTHWEST DENTAL CENTER, INC
Entity type:Organization
Organization Name:NORTHWEST DENTAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NABAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-774-3710
Mailing Address - Street 1:21810 76TH AVE W
Mailing Address - Street 2:101
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7917
Mailing Address - Country:US
Mailing Address - Phone:425-774-3710
Mailing Address - Fax:425-774-3311
Practice Address - Street 1:21810 76TH AVE W
Practice Address - Street 2:101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7917
Practice Address - Country:US
Practice Address - Phone:425-774-3710
Practice Address - Fax:425-774-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty