Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE00008184 | WA |
Y | 1223D0004X | Dentist Anesthesiologist | DE00008184 | WA |
NPI | 1932217403 |
---|---|
Provider Name | Dr. David William Dormans |
First Address | Anacortes, WA 98221-0486 |
Second Address | Anacortes, WA 98221-8304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5038542 | (05) | WA |