Provider Demographics
NPI:1902356058
Name:ROSELIND NAM PLLC
Entity Type:Organization
Organization Name:ROSELIND NAM PLLC
Other - Org Name:PREMIER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSELIND
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MMSC
Authorized Official - Phone:253-642-6301
Mailing Address - Street 1:9901 SE SHORELAND DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6508
Mailing Address - Country:US
Mailing Address - Phone:253-642-6301
Mailing Address - Fax:
Practice Address - Street 1:23535 NE NOVELTY HILL RD # D308
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5502
Practice Address - Country:US
Practice Address - Phone:253-642-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601396541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty