Provider Demographics
NPI:1922836832
Name:JEANINE E NORDEEN DDS, PLLC
Entity type:Organization
Organization Name:JEANINE E NORDEEN DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-670-0054
Mailing Address - Street 1:730 SUTTER LN SE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1464
Mailing Address - Country:US
Mailing Address - Phone:707-670-0054
Mailing Address - Fax:
Practice Address - Street 1:8765 TALLON LN NE STE I
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6654
Practice Address - Country:US
Practice Address - Phone:360-878-2931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty