Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | NT003 | WA |
NPI | 1821518937 |
---|---|
Provider Name | Dr. Rick Michael Miller |
First Address | Kalispell, MT 59901 |
Second Address | Kalispell, MT 59901-2858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2017 |
Last Update Date | 21/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NT003 | TRIBAL LICENSE (01) | WA |