Provider Demographics
NPI:1427504091
Name:NAKANO, NATHAN (DMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:NAKANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:
Other - Last Name:NAKANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3475 N SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98278-4927
Mailing Address - Country:US
Mailing Address - Phone:360-257-4471
Mailing Address - Fax:
Practice Address - Street 1:3475 N SARATOGA ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-4927
Practice Address - Country:US
Practice Address - Phone:360-257-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist