Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 009648 | CT |
N | 122300000X | Dentist | 053094 | NY |
N | 1223E0200X | Endodontist | DE 60586504 | WA |
Y | 1223X0400X | Orthodontists | DE 60586504 | WA |
NPI | 1114139599 |
---|---|
Provider Name | Dr. Adam Pristera |
First Address | Renton, WA 98055-5777 |
Second Address | Renton, WA 98055-5777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2007 |
Last Update Date | 08/09/2015 |