Provider Demographics
NPI:1366719254
Name:3D MAXILLOFACIAL IMAGING, PLLC
Entity type:Organization
Organization Name:3D MAXILLOFACIAL IMAGING, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-529-4111
Mailing Address - Street 1:213 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3002
Mailing Address - Country:US
Mailing Address - Phone:509-529-4111
Mailing Address - Fax:509-526-5295
Practice Address - Street 1:213 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3002
Practice Address - Country:US
Practice Address - Phone:509-529-4111
Practice Address - Fax:509-526-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology