Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000313 | WA |
NPI | 1306023213 |
---|---|
Provider Name | Mr. Mauricio Jesus Henriquez |
First Address | Bellevue, WA 98008-4637 |
Second Address | Bellevue, WA 98008-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 23/01/2008 |