Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE60472972 | WA |
NPI | 1699163501 |
---|---|
Provider Name | Dallas Easter |
First Address | Yakima, WA 98901-3020 |
Second Address | Yakima, WA 98901-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2014 |
Last Update Date | 22/01/2015 |