Provider Demographics
NPI:1972637825
Name:NORDLUND, DENNIS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:P
Last Name:NORDLUND
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 1:6720 FORT DENT WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2580
Mailing Address - Country:US
Mailing Address - Phone:206-439-0403
Mailing Address - Fax:
Practice Address - Street 1:6720 FORT DENT WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2580
Practice Address - Country:US
Practice Address - Phone:206-439-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist