# NORTHWEST DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073406716
- **Authorized official:** BRENT RISING (MEMBER)
- **Authorized official phone:** (701) 799-6453

## Contact information

- **Practice address:** 5200 N 91ST AVE, OMAHA, NE 68134-2749
- **Practice address phone:** (402) 572-7677
- **Mailing address:** 27330 W CENTER RD, WATERLOO, NE 68069-6814
- **Mailing address phone:** (701) 799-6453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/02/2025
- **Last updated:** 06/02/2025