Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 00000473 | WA |
NPI | 1033365788 |
---|---|
Provider Name | Mr. Michael D. Ankermiller |
First Address | Benton City, WA 99320-1400 |
Second Address | Prosser, WA 99350-1423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 22/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5056965 | DEPARTMENT OF SOCIAL AND HEALTH SERVICES (01) | WA |