Provider Demographics
NPI:1336243765
Name:NORDLAND, WENDELL PETER (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:PETER
Last Name:NORDLAND
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:PETER
Other - Last Name:NORDLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD MS
Mailing Address - Street 1:850 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-459-7374
Mailing Address - Fax:858-459-0057
Practice Address - Street 1:850 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-459-7374
Practice Address - Fax:858-459-0057
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery