Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN328 | WA |
NPI | 1831303270 |
---|---|
Provider Name | Melissa June Loucks |
First Address | Spokane, WA 99207-3269 |
Second Address | Spokane, WA 99207-3269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5040530 | (05) | WA |