Provider Demographics
NPI:1609972439
Name:NAKADATE, DEAN T (DPM)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:T
Last Name:NAKADATE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:541-317-5600
Mailing Address - Fax:541-317-5676
Practice Address - Street 1:929 SW SIMPSON AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3599
Practice Address - Country:US
Practice Address - Phone:541-317-5600
Practice Address - Fax:541-317-5676
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00442213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery