Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 6738 | WA |
N | 1223X0400X | Orthodontists | 6738 | WA |
NPI | 1104806918 |
---|---|
Provider Name | Dr. Andrew J Kapust |
First Address | Tumwater, WA 98501-3342 |
Second Address | Tumwater, WA 98501-3342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 08/07/2007 |