Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1447763404 |
---|---|
Provider Name | Dongxia Wang |
First Address | Spanaway, WA 98387-8321 |
Second Address | Spanaway, WA 98387-8321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 13/11/2017 |