Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000044 | WA |
NPI | 1932267945 |
---|---|
Provider Name | Mr. Gary Richard Fox |
First Address | Spokane, WA 99223-3832 |
Second Address | Spokane, WA 99223-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5021027 | (05) | WA |
91062 | WDS DELTA DENTAL (01) | WA |