Provider Demographics
NPI:1780134106
Name:WAKEFIELD, DILLEN
Entity type:Individual
Prefix:
First Name:DILLEN
Middle Name:
Last Name:WAKEFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NW GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2078
Mailing Address - Country:US
Mailing Address - Phone:541-383-4293
Mailing Address - Fax:541-383-4935
Practice Address - Street 1:23 NW GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2078
Practice Address - Country:US
Practice Address - Phone:541-383-4293
Practice Address - Fax:541-383-4935
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist