Provider Demographics
NPI:1285410340
Name:ERIC NORDSTROM DDS, MD, INC
Entity type:Organization
Organization Name:ERIC NORDSTROM DDS, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:907-222-5052
Mailing Address - Street 1:3909 ARCTIC BLVD STE 404
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5769
Mailing Address - Country:US
Mailing Address - Phone:907-222-5052
Mailing Address - Fax:907-222-5051
Practice Address - Street 1:3909 ARCTIC BLVD STE 404
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5769
Practice Address - Country:US
Practice Address - Phone:907-222-5052
Practice Address - Fax:907-222-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty