MEDICARE: DR. DENNIS P. NORDLUND D.D.S.

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
1	122300000X	Dentist	DE00004782	WA

General Provider Information

NPI Number	:	1972637825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS P. NORDLUND D.D.S.

Provider Business Mailing Address
First Line	:	6720 FORT DENT WAY
Second Line	:	SUITE 200
City	:	TUKWILA
State	:	WA
Zip	:	98188-2580
Country	:	US
Telephone Number	:	206-439-0403
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 FORT DENT WAY
Second Line	:	SUITE 200
City	:	TUKWILA
State	:	WA
Zip	:	98188-2580
Country	:	US
Telephone Number	:	206-439-0403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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