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NPI Code Detail

MEDICARE: RUSSELL K. NOMI, DDS, PS

MEDICARE: RUSSELL K. NOMI, DDS, PS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5604WA

General Provider Information

NPI Number : 1932229168
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL K. NOMI, DDS, PS
Provider Business Mailing Address
First Line : 6507 132ND AVE NE
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-8628
Country : US
Telephone Number : 425-881-9333
Fax Number : 425-881-2333
Provider Business Practice Location Address
First Line : 6507 132ND AVE NE
Second Line :
City : KIRKLAND
State : WA
Zip : 98033-8628
Country : US
Telephone Number : 425-881-9333
Fax Number : 425-881-2333
Authorized Official
Title or Position : DENTIST
Name : DR. RUSSELL K NOMI
Credential : DDS
Telephone Number : 425-881-9333
Provider Enumeration Date : 03/30/2007
Last Update Date : 06/16/2008

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