Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000019 | WA |
NPI | 1730171703 |
---|---|
Provider Name | Michael Gillispie |
First Address | Sequim, WA 98382-3350 |
Second Address | Sequim, WA 98382-3350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |