Provider Demographics
NPI:1023365764
Name:NORDQUIST, AMY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:NORDQUIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E ZION WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5191
Mailing Address - Country:US
Mailing Address - Phone:480-706-0029
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST STE 190
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9140
Practice Address - Country:US
Practice Address - Phone:480-706-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0084271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice