Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5377 | WA |
NPI | 1003874330 |
---|---|
Provider Name | Dr. John Lee Starks |
First Address | Seattle, WA 98101 |
Second Address | Seattle, WA 98101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |