Provider Demographics
NPI:1437944857
Name:NORDLIE, ANDREW MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARK
Last Name:NORDLIE
Suffix:
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 1:21421 SNAG ISLAND DR E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8709
Mailing Address - Country:US
Mailing Address - Phone:253-561-2294
Mailing Address - Fax:
Practice Address - Street 1:2505 S 320TH ST STE 330
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5461
Practice Address - Country:US
Practice Address - Phone:206-400-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE616617571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics