Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | WA |
NPI | 1386782282 |
---|---|
Provider Name | Mr. Lenard Gobin Deochand |
First Address | Vancouver, WA 98660-2220 |
Second Address | Vancouver, WA 98660-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278500 | (05) | OR |
5047667 | (05) | WA |
8942843 | CRIME VICTIM COMP. PROGRA (01) | WA |