Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 60555369 | WA |
NPI | 1164815569 |
---|---|
Provider Name | Joseph Garcia |
First Address | Seattle, WA 98102-2003 |
Second Address | Seattle, WA 98102-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2015 |
Last Update Date | 02/07/2015 |