Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60530830 | WA |
NPI | 1598142804 |
---|---|
Provider Name | Melissa Brulotte |
First Address | Bellingham, WA 98225-2411 |
Second Address | Bellingham, WA 98225-2411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/05/2015 |