Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 00000017 | WA |
NPI | 1437376068 |
---|---|
Provider Name | Andon Dan Allen |
First Address | Tulalip, WA 98271-6531 |
Second Address | Lynnwood, WA 98036-5959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5038724 | (05) | WA |