Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE61187204 | WA |
NPI | 1033873203 |
---|---|
Provider Name | Dr. Sogol Seghatoleslami |
First Address | Kennewick, WA 99336-8224 |
Second Address | Kennewick, WA 99336-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 30/10/2021 |