Provider Demographics
NPI:1255041034
Name:NORDSTROM ORTHODONTICS LLC
Entity type:Organization
Organization Name:NORDSTROM ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:617-335-3015
Mailing Address - Street 1:18 MAPLE AVE # 117
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-3560
Mailing Address - Country:US
Mailing Address - Phone:617-335-3015
Mailing Address - Fax:
Practice Address - Street 1:1226 HARTFORD AVE STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7100
Practice Address - Country:US
Practice Address - Phone:401-331-7171
Practice Address - Fax:401-331-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty