Provider Demographics
NPI:1407913825
Name:HATA, LENORE S (DDS)
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:S
Last Name:HATA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3925
Mailing Address - Country:US
Mailing Address - Phone:541-754-2214
Mailing Address - Fax:541-754-6631
Practice Address - Street 1:2300 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3925
Practice Address - Country:US
Practice Address - Phone:541-754-2214
Practice Address - Fax:541-754-6631
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice