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General NPI Number Information
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NPI Number | 1851605448
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Entity Type | Individual
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Provider Name | ERIC DAVID NORDBERG DDS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 11025 CANYON RD E STE C
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City | PUYALLUP
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State | WA
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Zip | 98373-4268
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Country | US
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Telephone | 253-881-1896
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Fax | 253-446-7117
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Provider Business Mailing Address
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Address Line | 8102 66TH AVENUE CT E
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City | PUYALLUP
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State | WA
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Zip | 98371-5593
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Country | US
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Telephone | 253-881-1896
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Fax | 253-446-7117
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE60520428
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License Number State | WA
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