Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 28447 | CA |
NPI | 1003432709 |
---|---|
Provider Name | Dr. Ralph Donald Hawkins |
First Address | Bonney Lake, WA 98391-8240 |
Second Address | Bonney Lake, WA 98391-8240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2020 |
Last Update Date | 18/06/2020 |