Provider Demographics
NPI:1215001060
Name:NORDLAND, PAMELA K (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:K
Last Name:NORDLAND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S KYRENE ROAD, STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:NY
Mailing Address - Zip Code:85226-1638
Mailing Address - Country:US
Mailing Address - Phone:480-292-7725
Mailing Address - Fax:480-406-6532
Practice Address - Street 1:10 S KYRENE ROAD, STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:NY
Practice Address - Zip Code:85226-1638
Practice Address - Country:US
Practice Address - Phone:480-292-7725
Practice Address - Fax:480-406-6532
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009290122300000X
NY344141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603558Medicaid