Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60869545 | WA |
NPI | 1346713765 |
---|---|
Provider Name | Mr. Cody M Dunivin |
First Address | Longview, WA 98632-3738 |
Second Address | Longview, WA 98632-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2019 |
Last Update Date | 02/06/2021 |