Provider Demographics
NPI:1225588031
Name:ROBERT NORMAN NAU, DDS, LLC
Entity Type:Organization
Organization Name:ROBERT NORMAN NAU, DDS, LLC
Other - Org Name:OKANOGAN VALLEY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CLARKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-486-2902
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-0728
Mailing Address - Country:US
Mailing Address - Phone:509-486-2902
Mailing Address - Fax:509-486-2904
Practice Address - Street 1:202 SOUTH WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-0728
Practice Address - Country:US
Practice Address - Phone:509-486-2902
Practice Address - Fax:509-486-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000057411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty