Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 60976118 | WA |
NPI | 1033763800 |
---|---|
Provider Name | Dr. Joseph Robert Eidsness |
First Address | Anacortes, WA 98221-2739 |
Second Address | Anacortes, WA 98221-2739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2019 |
Last Update Date | 30/07/2019 |