Provider Demographics
NPI:1972038420
Name:MASUNAGA, TATE KEONE NOBUO (DMD)
Entity Type:Individual
Prefix:DR
First Name:TATE
Middle Name:KEONE NOBUO
Last Name:MASUNAGA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 WESTLAKE AVE N UNIT 539
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4881
Mailing Address - Country:US
Mailing Address - Phone:808-349-5953
Mailing Address - Fax:
Practice Address - Street 1:20709 MOUNTAIN HWY E STE 101
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8580
Practice Address - Country:US
Practice Address - Phone:253-948-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA60865193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program