Healthcare Provider Details

I. General information

NPI: 1205275658
Provider Name (Legal Business Name): DANIEL A RADATTI DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 NE 3RD ST STE. B-105
BEND OR
97701-3106
US

IV. Provider business mailing address

1250 NE 3RD ST STE. B-105
BEND OR
97701-3106
US

V. Phone/Fax

Practice location:
  • Phone: 541-617-9736
  • Fax:
Mailing address:
  • Phone: 541-617-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DANIEL ANGELO RADATTI
Title or Position: OWNER
Credential: DDS
Phone: 541-390-5415