Provider Demographics
NPI:1477633840
Name:RADATTI, DANIEL ANGELO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANGELO
Last Name:RADATTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1250 NE 3RD ST
Mailing Address - Street 2:SUITE B105
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3105
Mailing Address - Country:US
Mailing Address - Phone:541-617-9736
Mailing Address - Fax:541-617-9836
Practice Address - Street 1:1250 NE 3RD ST
Practice Address - Street 2:SUITE B105
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3105
Practice Address - Country:US
Practice Address - Phone:541-617-9736
Practice Address - Fax:541-617-9836
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD80711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics