Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000129 | WA |
NPI | 1194926915 |
---|---|
Provider Name | Mr. George A. Payne |
First Address | Wenatchee, WA 98801-2046 |
Second Address | Wenatchee, WA 98801-2046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |