Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60981457 | WA |
NPI | 1689339889 |
---|---|
Provider Name | Mr. Conor Carbone |
First Address | Olympia, WA 98506-5080 |
Second Address | Olympia, WA 98506-5080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2021 |
Last Update Date | 02/11/2021 |