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General NPI Number Information
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NPI Number | 1902356058
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Entity Type | Organization
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Legal Business Name | ROSELIND NAM PLLC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 23535 NE NOVELTY HILL RD # D308
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City | REDMOND
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State | WA
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Zip | 98053-5502
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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 | 253-642-6301
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | ROSELIND S NAM
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Credential | DMD, MMSC
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Telephone | 253-642-6301
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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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