Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000391 |
NPI | 1699801480 |
---|---|
Provider Name | Mr. Joshua Daniel Brooks |
First Address | Kennewick, WA 99336 |
Second Address | Kennewick, WA 99336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 24/08/2020 |