Provider Demographics
NPI:1003814781
Name:EDLUND, ROLF MELKER (DDS)
Entity Type:Individual
Prefix:
First Name:ROLF
Middle Name:MELKER
Last Name:EDLUND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 FRYAR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1501
Mailing Address - Country:US
Mailing Address - Phone:253-863-0444
Mailing Address - Fax:253-863-1936
Practice Address - Street 1:1006 FRYAR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1501
Practice Address - Country:US
Practice Address - Phone:253-863-0444
Practice Address - Fax:253-863-1936
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist