Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000197 | WA |
NPI | 1588700181 |
---|---|
Provider Name | Mr. John Richard Elvin |
First Address | Chehalis, WA 98532 |
Second Address | Chehalis, WA 98532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |