Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60034322 | WA |
NPI | 1811137813 |
---|---|
Provider Name | Mr. Herman Castaneda |
First Address | Mill Creek, WA 98012 |
Second Address | Mill Creek, WA 98012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2009 |
Last Update Date | 09/03/2009 |