Provider Demographics
NPI:1457350043
Name:NORDSTROM, DAVID W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:NORDSTROM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 BOISE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5016
Mailing Address - Country:US
Mailing Address - Phone:970-667-1236
Mailing Address - Fax:970-278-0365
Practice Address - Street 1:1907 BOISE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5016
Practice Address - Country:US
Practice Address - Phone:970-667-1236
Practice Address - Fax:970-278-0365
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1045181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice