Provider Demographics
NPI:1265575807
Name:NORDSTROM, JAMES IRA JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:IRA
Last Name:NORDSTROM
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SYLVAN VISTA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3223
Mailing Address - Country:US
Mailing Address - Phone:530-885-3144
Mailing Address - Fax:
Practice Address - Street 1:11526 C AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2704
Practice Address - Country:US
Practice Address - Phone:530-889-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice