Organization
MIRROR POND DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC ANDREW NORDSTROM DMD (MEMBER)
(541) 610-7837
Entity
Organization
Contact information
Practice address
1412 NE 134TH ST. SUITE 120, VANCOUVER, WA 98685
(360) 573-4848
Mailing address
1475 SW CHANDLER AVE STE 201, BEND, OR 97702-3240
(541) 610-7837
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60682826
WA
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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