Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000005 | WA |
N | 122400000X | Denturist | DTDO302276 | OR |
NPI | 1700938248 |
---|---|
Provider Name | Jana Moga |
First Address | Vancouver, WA 98663 |
Second Address | Vancouver, WA 98663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |