Provider Demographics
NPI:1942390083
Name:ROLF M. EDLUND, DDS, PS
Entity Type:Organization
Organization Name:ROLF M. EDLUND, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:MELKER
Authorized Official - Last Name:EDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-863-0444
Mailing Address - Street 1:1006 FRYAR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390
Mailing Address - Country:US
Mailing Address - Phone:253-863-0444
Mailing Address - Fax:253-863-1936
Practice Address - Street 1:1006 FRYAR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1501
Practice Address - Country:US
Practice Address - Phone:253-863-0444
Practice Address - Fax:253-863-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty