# MIRROR POND DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548719461
- **Authorized official:** MARC ANDREW NORDSTROM DMD (MEMBER)
- **Authorized official phone:** (541) 610-7837

## Contact information

- **Practice address:** 1412 NE 134TH ST. SUITE 120, VANCOUVER, WA 98685
- **Practice address phone:** (360) 573-4848
- **Mailing address:** 1475 SW CHANDLER AVE STE 201, BEND, OR 97702-3240
- **Mailing address phone:** (541) 610-7837

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE60682826 | WA | Yes |

## Other

- **Enumeration date:** 10/04/2016
- **Last updated:** 10/04/2016