Provider Demographics
NPI:1275286999
Name:NORDAHL DENTAL INC
Entity Type:Organization
Organization Name:NORDAHL DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-746-7008
Mailing Address - Street 1:838 NORDAHL RD STE 275
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-3595
Mailing Address - Country:US
Mailing Address - Phone:760-746-7008
Mailing Address - Fax:
Practice Address - Street 1:838 NORDAHL RD STE 275
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3595
Practice Address - Country:US
Practice Address - Phone:760-746-7008
Practice Address - Fax:760-746-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental