Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000049 | WA |
NPI | 1356653067 |
---|---|
Provider Name | Irma Tanchoco Alcantara |
First Address | Seattle, WA 98118 |
Second Address | Seattle, WA 98118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2010 |
Last Update Date | 10/07/2010 |