Andrew Mark Nordlie, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE61661757 Issued in WA

Practice address

2505 S 320TH St Ste 330
Federal Way, WA 98003-5461

Phone

(206) 400-0800

NPI assigned

Apr 14, 2025

Last updated

Apr 19, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745020800000",
    "number": "1437944857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21421 SNAG ISLAND DR E",
            "city": "LAKE TAPPS",
            "state": "WA",
            "postal_code": "983918709",
            "telephone_number": "253-561-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 S 320TH ST STE 330",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980035461",
            "telephone_number": "206-400-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDLIE",
        "first_name": "ANDREW",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-14",
        "last_updated": "2025-04-19",
        "certification_date": "2025-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE61661757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.