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General NPI Number Information
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NPI Number | 1174968507
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Entity Type | Organization
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Legal Business Name | NORTHWEST DENTAL CENTER, INC
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 21810 76TH AVE W 101
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City | EDMONDS
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State | WA
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Zip | 98026-7917
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Country | US
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Telephone | 425-774-3710
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Fax | 425-774-3311
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Provider Business Mailing Address
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Address Line | 21810 76TH AVE W 101
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City | EDMONDS
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State | WA
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Zip | 98026-7917
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Country | US
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Telephone | 425-774-3710
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Fax | 425-774-3311
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REZA NABAIE
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Credential | D.D.S.
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Telephone | 425-774-3710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE8781
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License Number State | WA
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