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General NPI Number Information
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NPI Number | 1649631342
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Entity Type | Organization
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Legal Business Name | NAM PLLC
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 5613 119TH AVE SE
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City | BELLEVUE
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State | WA
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Zip | 98006-3715
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Country | US
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Telephone | 253-642-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 9901 SE SHORELAND DR
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City | BELLEVUE
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State | WA
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Zip | 98004-6508
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Country | US
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Telephone | 425-890-3386
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Fax |
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Authorized Official
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Title or Position | DENTIST/ ORTHODONTIST
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Name | ROSELIND NAM
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Credential | DMD
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Telephone | 425-890-3386
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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 | DE60139654
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License Number State | WA
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