Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000009 | WA |
N | 122400000X | Denturist | LD14 | ID |
NPI | 1891881710 |
---|---|
Provider Name | Mr. Jody John Rowe |
First Address | Spokane Valley, WA 99206-5147 |
Second Address | Spokane Valley, WA 99206-5147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5024393 | (05) | WA |