Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60781690 | WA |
NPI | 1841765682 |
---|---|
Provider Name | Andrew Payne |
First Address | Wenatchee, WA 98801-2069 |
Second Address | Wenatchee, WA 98801-2069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2018 |
Last Update Date | 08/10/2018 |