Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4759 | WA |
NPI | 1003960238 |
---|---|
Provider Name | Dr. Bernie Kopfer |
First Address | Wenatchee, WA 98801-1285 |
Second Address | Wenatchee, WA 98801-3047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5042668 | (05) | WA |
5399209 | (05) | WA |