Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD00014194 | WA |
NPI | 1124116611 |
---|---|
Provider Name | Bruce Howard Dentler |
First Address | Spokane, WA 99208-4257 |
Second Address | Spokane, WA 99208-4257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073923 | (05) | WA |
A07158 | (02) | WA |