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Biotechnology applications are increasingly turning to CMOS integrated biosensor arrays for massive parallelism and increased throughput in biomolecular diagnostics. Yet many opportunities still remain to take advantage of the spatially-resolved nature of dense semiconductor platforms to open up new imaging dimensions which complement traditional microscopy. To better understand the emergence of spatial organization in living systems, we require techniques that dynamically probe the spatial structure of assemblies of millions of cells or more. Optical microscopy is the dominant technique, but large field-of-view microscopes have an inherent tradeoff with resolving fine features. Confocal microscopes can image cellular-scale 3D structures, but their bright illumination can impart severe phototoxicity, and observing large areas can be prohibitively slow. Here we present an integrated CMOS sensor array with 131,072 pixels, which is designed to electrochemically image and interface with bacterial biofilms.