Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | D1 60285302 | WA |
NPI | 1215363130 |
---|---|
Provider Name | Monique Kristenelly Belbis |
First Address | Shoreline, WA 98155 |
Second Address | Lynnwood, WA 98037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2013 |
Last Update Date | 24/09/2013 |