Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | ||
N | 122400000X | Denturist | DN60737872 | WA |
NPI | 1740700145 |
---|---|
Provider Name | Mr. Joseph Brandon Kimmel |
First Address | Hillsboro, OR 97124-5611 |
Second Address | Tacoma, WA 98409-9908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN60737872 | DENTURIST LICENSE (01) | WA |