Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000125 | WA |
NPI | 1619058179 |
---|---|
Provider Name | Mark Charles Mercer |
First Address | Chehalis, WA 98532-3425 |
Second Address | Chehalis, WA 98532-3425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |