Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D-1452-OR | ID |
NPI | 1033395132 |
---|---|
Provider Name | John William Vornholt |
First Address | Clarkston, WA 99403-3058 |
Second Address | Clarkston, WA 99403-3058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2008 |
Last Update Date | 18/01/2008 |