Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000360 | WA |
NPI | 1194850073 |
---|---|
Provider Name | Mr. Dung Q Pham |
First Address | Everett, WA 98208-1846 |
Second Address | Everett, WA 98208-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 26/04/2013 |