Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000381 | WA |
NPI | 1679799449 |
---|---|
Provider Name | Dr. Samuel Edward Whisenant JR. |
First Address | Kent, WA 98030-6853 |
Second Address | Kent, WA 98030-6853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5047857 | PROVIDER (01) | WA |