Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE00005097 | WA |
NPI | 1730430356 |
---|---|
Provider Name | Dr. Forrest Harrison Peebles |
First Address | Seattle, WA 98127-1824 |
Second Address | Seattle, WA 98117-2425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 01/07/2015 |