Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000119 | WA |
NPI | 1922329713 |
---|---|
Provider Name | Alan Arthur Anderson |
First Address | Tacoma, WA 98465-1610 |
Second Address | Tacoma, WA 98465-1610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1922329713 | (05) | WA |