Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 60034347 | WA |
NPI | 1871813121 |
---|---|
Provider Name | Mr. Frankie Roberto Flores |
First Address | Spokane, WA 99205-5944 |
Second Address | Spokane, WA 99207-2253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2010 |
Last Update Date | 09/06/2010 |