Organization
NORTHWEST ORAL HEALTH OUTREACH LLC
Active
Other names
Northwest Oral Health Outreach
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDEN J DAVIS DMD, MPH (CEO)
(509) 607-1872
Entity
Organization
Contact information
Practice address
2353 LOWER GREEN CANYON RD, ELLENSBURG, WA 98926-8514
(509) 607-1872
Mailing address
2353 LOWER GREEN CANYON RD, ELLENSBURG, WA 98926-8514
(509) 607-1872
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
603513887
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0255549
LABOR & INDUSTRIES
WA
05
—
5060215
—
WA
Enumeration date
08/21/2015
Last updated
08/21/2015
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