Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DE 60277222 | WA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DE60277222 | WA |
NPI | 1417269200 |
---|---|
Provider Name | Dr. Matthew Shane Epstein |
First Address | Seattle, WA 98103-4800 |
Second Address | Seattle, WA 98103-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 13/01/2022 |