Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000422 | WA |
NPI | 1982721759 |
---|---|
Provider Name | Mr. Frederick Karl Swank |
First Address | Kirkland, WA 98034-1931 |
Second Address | Kirkland, WA 98034-1931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2007 |
Last Update Date | 08/07/2007 |