Northwest Oral Health Outreach LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

603513887 Issued in WA

Legal business name

NORTHWEST ORAL HEALTH OUTREACH LLC

Doing business as

Northwest Oral Health Outreach

Practice address

2353 Lower Green Canyon Rd
Ellensburg, WA 98926-8514

Phone

(509) 607-1872

NPI assigned

Aug 21, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brenden J Davis, DMD, MPHNPI 1538391040

Title

Ceo

Phone

(509) 607-1872

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Northwest Oral Health Outreach Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brenden J Davis, DMD, MPH

  • Dentist
  • Kennewick, WA
  • NPI 1538391040
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1629445929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 LOWER GREEN CANYON RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989268514",
            "telephone_number": "509-607-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2353 LOWER GREEN CANYON RD",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989268514",
            "telephone_number": "509-607-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ORAL HEALTH OUTREACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRENDEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-607-1872",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MPH"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "603513887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0255549",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5060215",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Oral Health Outreach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mila L. Nelson, AUD, CCC-A, FAAA
• Casey Marie Neumeier
• Anna Marie Newman, LMP
• Sarah Katherine Newton, OTR/L
• Carmen Michelle Nored, FNP
• Mary C. Nouwens, ARNP
• Kelly Maureen Noyes, D.O.
• Kodi Null
• Andrew Masato Numa, BSCPHARM
• Timothy J O'Brien, MD

• Dental Clinic/Center in Ellensburg, WA
• Providers in Ellensburg, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.