Provider Demographics
NPI:1922499243
Name:NORDSTROM, BARRETT KYLE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:KYLE
Last Name:NORDSTROM
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:18 MAPLE AVE # 117
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3560
Mailing Address - Country:US
Mailing Address - Phone:617-335-3015
Mailing Address - Fax:
Practice Address - Street 1:1226 HARTFORD AVE STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7100
Practice Address - Country:US
Practice Address - Phone:401-331-7171
Practice Address - Fax:401-331-2755
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDEN034811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics