Organization
MIRROR POND DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC NORDSTROM DMD (OWNER)
(541) 382-2256
Entity
Organization
Contact information
Practice address
102 NW NEWPORT AVE, BEND, OR 97703-1838
(541) 382-2256
(541) 389-5229
Mailing address
102 NW NEWPORT AVE, BEND, OR 97703-1838
(541) 382-2256
(541) 389-5229
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7335
OR
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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