Provider Demographics
NPI:1174725758
Name:OGATA, RANDALL HEISUKE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:HEISUKE
Last Name:OGATA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 NE 45TH PLACE
Mailing Address - Street 2:SUITE 300WW
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4028
Mailing Address - Country:US
Mailing Address - Phone:206-523-3322
Mailing Address - Fax:206-522-2512
Practice Address - Street 1:3216 NE 45TH PLACE
Practice Address - Street 2:SUITE 300WW
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4028
Practice Address - Country:US
Practice Address - Phone:206-523-3322
Practice Address - Fax:206-522-2512
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000069291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics