Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 00007009 | WA |
NPI | 1013482512 |
---|---|
Provider Name | Michelle Bale |
First Address | Mukilteo, WA 98275-3426 |
Second Address | Bainbridge Island, WA 98110-4915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 10/10/2018 |