Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000363 | WA |
NPI | 1780118638 |
---|---|
Provider Name | Mr. Joseph Christian Vize |
First Address | Pasco, WA 99301-3875 |
Second Address | Pasco, WA 99301-3875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 18/04/2017 |