Provider Demographics
NPI:1023253424
Name:KIM D NORDBERG DDS, PS
Entity type:Organization
Organization Name:KIM D NORDBERG DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NORDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-535-6666
Mailing Address - Street 1:11023 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-4264
Mailing Address - Country:US
Mailing Address - Phone:253-535-6666
Mailing Address - Fax:253-535-5432
Practice Address - Street 1:11023 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4264
Practice Address - Country:US
Practice Address - Phone:253-535-6666
Practice Address - Fax:253-535-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty