Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DH60550988 | WA |
NPI | 1720586324 |
---|---|
Provider Name | David Combs |
First Address | Los Angeles, CA 90025 |
Second Address | Losangeles, WA 90025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2018 |
Last Update Date | 29/01/2018 |