Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000392 | WA |
NPI | 1982704094 |
---|---|
Provider Name | Anthony J. Hansen |
First Address | Bellingham, WA 98226-5643 |
Second Address | Bellingham, WA 98226-5643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5047444 | (05) | WA |