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General NPI Number Information
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NPI Number | 1255041034
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Entity Type | Organization
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Legal Business Name | NORDSTROM ORTHODONTICS LLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1226 HARTFORD AVE STE 101
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City | JOHNSTON
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State | RI
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Zip | 02919-7100
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Country | US
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Telephone | 401-331-7171
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Fax | 401-331-2755
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Provider Business Mailing Address
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Address Line | 18 MAPLE AVE # 117
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City | BARRINGTON
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State | RI
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Zip | 02806-3560
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Country | US
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Telephone | 617-335-3015
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BARRETT NORDSTROM
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Credential | DDS, MS
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Telephone | 617-335-3015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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