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NORTHWEST DENTAL GROUP, PLLC

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Company Details

Legal Name: NORTHWEST DENTAL GROUP, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: November 15th 2023
Expiration date: 30 Nov 2025
UBI Number: 605 366 629
ZIP code: 98367
City: Port Orchard
County: KITSAP
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 417 SW SEDGWICK RD STE 101, PORT ORCHARD, WA, 98367-6449, UNITED STATES

Contact Details

E-Mail: PMAKADIADDS@GMAIL.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
PRASHANT MAKADIA Registered Agent 417 SW SEDGWICK RD STE 101, PORT ORCHARD, WA, 98367-6449, UNITED STATES

Key Officers & Management

Name Role Address
PRASHANT MAKADIA Governing Person -
BRIAN KERR Governing Person -
KIM NORDBERG DDS EXECUTOR 605 5TH AVE S STE 900, SEATTLE, WA, 98104-3865, UNITED STATES

National Provider Identifier

NPI Number:
1407625320
Certification Date:
2023-12-20

Authorized Person:

Name:
MS. MEAGAN MARIE MURPHY
Role:
CORPORATE LAISON
Phone:

Taxonomy:

Selected Taxonomy:
122300000X - Dentist
Is Primary:
Yes

Contacts:

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