Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000135 | WA |
NPI | 1437213311 |
---|---|
Provider Name | Mr. Donald Kenneth Mathews |
First Address | Aberdeen, WA 98520-4133 |
Second Address | Aberdeen, WA 98520-4133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |