Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 0254 | WA |
NPI | 1306048111 |
---|---|
Provider Name | Mr. Kevin C Kowalski |
First Address | Mount Vernon, WA 98273-2403 |
Second Address | Mount Vernon, WA 98273-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5032990 | (05) | WA |
891432 | UNITED CONCORDIA (01) | WA |