Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN370 | WA |
NPI | 1588864383 |
---|---|
Provider Name | Mr. Michael Curtis Talbott |
First Address | Yakima, WA 98901-2300 |
Second Address | Yakima, WA 98901-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 19/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5053228 | DSHS (01) | WA |