Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DE00007078 | WA |
NPI | 1154541084 |
---|---|
Provider Name | David Myaskovsky |
First Address | Bothell, WA 98012-8572 |
Second Address | Bothell, WA 98012-8572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 29/06/2021 |