NPIMap

Organization Active NPI

Imholte & Anderson PLLC

Doing business as Twin City Dental

  • General Practice Dentistry
  • Kelso, WA
National Provider Identifier
1942318829
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4754 Issued in WA
Legal business name
IMHOLTE & ANDERSON PLLC
Doing business as
Twin City Dental
Practice address
409 West Main Street
Kelso, WA 98626
Phone
(360) 577-1153
Fax
(360) 425-1540
NPI assigned
Aug 29, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Pennie Lyn Broyles
Title
Office Manager
Phone
(360) 577-1153

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 4754 WA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 8788 WA

Addresses

Primary practice location

409 West Main Street
Kelso, WA 98626

Mailing address

409 West Main Street
Kelso, WA 98626
Phone (360) 577-1153

Other names 1

  • Twin City Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942318829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 WEST MAIN STREET",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "98626",
            "telephone_number": "360-577-1153",
            "fax_number": "360-425-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 WEST MAIN STREET",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "98626",
            "telephone_number": "360-577-1153",
            "fax_number": "360-425-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMHOLTE & ANDERSON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROYLES",
        "authorized_official_first_name": "PENNIE",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-577-1153"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "4754",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "8788",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twin City Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kelso, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.