Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60404130 | WA |
NPI | 1407305816 |
---|---|
Provider Name | Michael Grishin |
First Address | Spokane, WA 99207-5074 |
Second Address | Spokane, WA 99202-4868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2016 |
Last Update Date | 26/09/2016 |