Provider Demographics
NPI:1568405082
Name:NODTVEDT, STEVEN WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:NODTVEDT
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 1:27115 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7009
Mailing Address - Country:US
Mailing Address - Phone:253-854-5748
Mailing Address - Fax:253-854-5770
Practice Address - Street 1:27115 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7009
Practice Address - Country:US
Practice Address - Phone:253-854-5748
Practice Address - Fax:253-854-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000060131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-128-3717OtherTAX ID NUMBER