Provider Demographics
NPI:1982685665
Name:NORDSTROM, WILLIAM RANDALL (DDS/ FAGD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDALL
Last Name:NORDSTROM
Suffix:
Gender:M
Credentials:DDS/ FAGD
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Mailing Address - Street 1:4101 WOOLWORTH AVE
Mailing Address - Street 2:NWIHCS- DEPT. OF VETERAN AFFAIRS
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1850
Mailing Address - Country:US
Mailing Address - Phone:402-346-8800
Mailing Address - Fax:402-995-5993
Practice Address - Street 1:4101 WOOLWORTH AVE
Practice Address - Street 2:NWIHCS- DEPT. OF VETERAN AFFAIRS
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:402-346-8800
Practice Address - Fax:402-995-5993
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE54791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice