Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60404068 | WA |
NPI | 1720417041 |
---|---|
Provider Name | Cody Carson |
First Address | Bellingham, WA 98225-2411 |
Second Address | Bellingham, WA 98225-2411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 07/11/2013 |