Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60041183 | WA |
NPI | 1053884338 |
---|---|
Provider Name | Mr. Juan Edward Berlanga |
First Address | Tacoma, WA 98406-1724 |
Second Address | Tacoma, WA 98406-1724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 10/01/2019 |