Provider Demographics
NPI:1992038343
Name:NORDAHL, ELSA KARIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:KARIN
Last Name:NORDAHL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21302 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9584
Mailing Address - Country:US
Mailing Address - Phone:360-607-6761
Mailing Address - Fax:
Practice Address - Street 1:9300 NE VANCOUVER MALL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-8201
Practice Address - Country:US
Practice Address - Phone:360-253-6375
Practice Address - Fax:360-253-6437
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60103959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist