Provider Demographics
NPI:1760524276
Name:OCONNOR, NATHAN ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANDREW
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SO 40TH AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3867
Mailing Address - Country:US
Mailing Address - Phone:509-966-0660
Mailing Address - Fax:509-965-0417
Practice Address - Street 1:1015 SO 40TH AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3867
Practice Address - Country:US
Practice Address - Phone:509-966-0660
Practice Address - Fax:509-965-0417
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA104921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051057Medicaid