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General NPI Number Information
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NPI Number | 1437944857
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Entity Type | Individual
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Provider Name | ANDREW MARK NORDLIE DDS
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Gender | Male
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 2505 S 320TH ST STE 330
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5461
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Country | US
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Telephone | 206-400-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 21421 SNAG ISLAND DR E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-8709
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Country | US
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Telephone | 253-561-2294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE61661757
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License Number State | WA
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