Provider Demographics
NPI:1588111702
Name:STEVEN W NODTVEDT DDS
Entity type:Organization
Organization Name:STEVEN W NODTVEDT DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NODTVEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-854-5748
Mailing Address - Street 1:27115 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7009
Mailing Address - Country:US
Mailing Address - Phone:253-854-5748
Mailing Address - Fax:
Practice Address - Street 1:27115 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7009
Practice Address - Country:US
Practice Address - Phone:253-854-5748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty