Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000121 | WA |
NPI | 1386799856 |
---|---|
Provider Name | Angelica Patricia Collantes Summer |
First Address | Seattle, WA 98125-6322 |
Second Address | Seattle, WA 98125-6322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |