Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000457 | WA |
NPI | 1659596955 |
---|---|
Provider Name | Mr. Logan V May |
First Address | Vancouver, WA 98683-9033 |
Second Address | Vancouver, WA 98683-9033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |