Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DE00009240 | WA |
NPI | 1982662482 |
---|---|
Provider Name | Dr. Scott Clayhold |
First Address | Issaquah, WA 98029-5289 |
Second Address | Issaquah, WA 98029-5289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |