Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60778096 | WA |
NPI | 1093372039 |
---|---|
Provider Name | Austin Mitchell Newsome |
First Address | Montclair, CA 91763-2424 |
Second Address | Seaside, OR 97138-6619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2019 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN60778096 | WASHINGTON DEPARTMENT OF HEALTH (01) | WA |
T-10196427 | OREGON DEPARTMENT OF HEALTH (01) | OR |