Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4139 | WA |
NPI | 1003986159 |
---|---|
Provider Name | Dr. Richard H. Tangen |
First Address | Poulsbo, WA 98370-9099 |
Second Address | Poulsbo, WA 98370-9099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |