Provider Demographics
NPI:1871049593
Name:DENNIS P. NORDLUND, DDS
Entity type:Organization
Organization Name:DENNIS P. NORDLUND, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-439-0403
Mailing Address - Street 1:6720 FORT DENT WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2580
Mailing Address - Country:US
Mailing Address - Phone:206-439-0403
Mailing Address - Fax:
Practice Address - Street 1:6720 FORT DENT WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2580
Practice Address - Country:US
Practice Address - Phone:206-439-0403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty