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Individual

DR. R DEAN NYQUIST

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
D.M.D.

Contact information

Practice address
1230 NE 3RD ST, SUITE A-174, BEND, OR 97701-4367
(541) 389-6600
(541) 389-2965
Mailing address
1230 NE 3RD ST, SUITE A-174, BEND, OR 97701-4367
(541) 389-6600
(541) 389-2965

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
24157
CA
1223P0221X
Pediatric Dentistry
Primary
4651
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13683-8
OREGON HEALTH PLAN
OR
Enumeration date
08/25/2005
Last updated
07/08/2007
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