Provider Demographics
NPI:1891035085
Name:ORTGIES NAKAMURA, DENA LAREE (RDH)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:LAREE
Last Name:ORTGIES NAKAMURA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 HERRIOT DR
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-2031
Mailing Address - Country:US
Mailing Address - Phone:608-847-6700
Mailing Address - Fax:608-847-6122
Practice Address - Street 1:880 HERRIOT DR
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-2031
Practice Address - Country:US
Practice Address - Phone:608-847-6700
Practice Address - Fax:608-847-6122
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA11330-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist