Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60404431 | WA |
NPI | 1174953277 |
---|---|
Provider Name | Dexter Gruver |
First Address | Gig Harbor, WA 98335-2057 |
Second Address | Gig Harbor, WA 98335-2057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2013 |
Last Update Date | 26/11/2013 |