Provider Demographics
NPI:1952482572
Name:THOMAS B. NORDTVEDT, DDS, APC
Entity Type:Organization
Organization Name:THOMAS B. NORDTVEDT, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORDTVEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-225-8228
Mailing Address - Street 1:1621 TONGASS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6013
Mailing Address - Country:US
Mailing Address - Phone:907-225-8228
Mailing Address - Fax:907-225-8224
Practice Address - Street 1:1621 TONGASS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6013
Practice Address - Country:US
Practice Address - Phone:907-225-8228
Practice Address - Fax:907-225-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0 378Medicaid