Provider Demographics
NPI:1972740108
Name:DEAN T NAKADATE DPM PC
Entity Type:Organization
Organization Name:DEAN T NAKADATE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NAKADATE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-383-3668
Mailing Address - Street 1:1506 NE WILLIAMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6071
Mailing Address - Country:US
Mailing Address - Phone:541-383-3668
Mailing Address - Fax:541-383-4546
Practice Address - Street 1:1506 NE WILLIAMSON BLVD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6071
Practice Address - Country:US
Practice Address - Phone:541-383-3668
Practice Address - Fax:541-383-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00442213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty