Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 4068 | WA |
NPI | 1912079112 |
---|---|
Provider Name | Gerald George Dolgash |
First Address | Olympia, WA 98506-5220 |
Second Address | Olympia, WA 98506-5220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 19/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1912079112 | NPI (01) | |
5005046 | (05) | WA |
T02868 | (02) |