Provider Demographics
NPI:1891913786
Name:NORD, RALPH ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:ALAN
Last Name:NORD
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 1:11066 5TH AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6156
Mailing Address - Country:US
Mailing Address - Phone:206-363-1464
Mailing Address - Fax:
Practice Address - Street 1:11066 5TH AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6156
Practice Address - Country:US
Practice Address - Phone:206-363-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice