Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60833384 | WA |
NPI | 1932697117 |
---|---|
Provider Name | Mr. Jason Lee Alsbury |
First Address | Kennewick, WA 99336-3378 |
Second Address | Kennewick, WA 99336-3378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 24/04/2018 |