Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000024 | WA |
NPI | 1659574523 |
---|---|
Provider Name | Michael Puderbaugh |
First Address | Bellingham, WA 98226-9278 |
Second Address | Bellingham, WA 98226-9278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 08/07/2007 |