Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE00006239 | WA |
NPI | 1073697116 |
---|---|
Provider Name | Jon L Way |
First Address | Seattle, WA 98103-5422 |
Second Address | Seattle, WA 98105-3925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 13/08/2015 |