Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000447 | WA |
NPI | 1740470533 |
---|---|
Provider Name | Danny R. Croft |
First Address | College Place, WA 99324 |
Second Address | College Place, WA 99324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2007 |
Last Update Date | 27/07/2007 |