Provider Demographics
NPI:1326457219
Name:REPTA, NATANAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATANAEL
Middle Name:
Last Name:REPTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 PENDLETON WAY
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-4203
Mailing Address - Country:US
Mailing Address - Phone:360-835-3738
Mailing Address - Fax:
Practice Address - Street 1:275 PENDLETON WAY
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-835-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist