Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000399 | WA |
NPI | 1417001280 |
---|---|
Provider Name | Michael Matthew Coffey |
First Address | Port Angeles, WA 98362-3320 |
Second Address | Port Angeles, WA 98362-3320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5048269 | (05) | WA |