Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60318376 | WA |
NPI | 1992049647 |
---|---|
Provider Name | Mr. Blaine Irving Turner |
First Address | Yakima, WA 98902-3110 |
Second Address | Yakima, WA 98902-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2012 |
Last Update Date | 19/11/2012 |