Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-163846 | OR |
NPI | 1609088665 |
---|---|
Provider Name | Miroslaw Antoni Zychla |
First Address | Vancouver, WA 98661-7521 |
Second Address | Hillsboro, OR 97124-5611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |