Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE00010112 | WA |
NPI | 1003920612 |
---|---|
Provider Name | Dr. David A Tegrotenhuis |
First Address | Friday Harbor, WA 98250-8070 |
Second Address | Friday Harbor, WA 98250-8070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 27/06/2012 |