Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 25099 | TX |
Y | 1223E0200X | Endodontist | DE60717233 | WA |
NPI | 1144476813 |
---|---|
Provider Name | Dr. Gavin Convey |
First Address | Kirkland, WA 98034-5831 |
Second Address | Kirkland, WA 98034-7208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 17/03/2018 |