Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000292 | WA |
NPI | 1093907222 |
---|---|
Provider Name | James M Elvin |
First Address | Lacey, WA 98509-3221 |
Second Address | Olympia, WA 98506-4484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2007 |
Last Update Date | 12/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5039920 | (05) | WA |