Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN 60153167 | WA |
N | 122400000X | Denturist | DT-DO-10111220 | OR |
NPI | 1801010046 |
---|---|
Provider Name | Mr. Michael Neil Holden |
First Address | Kent, WA 98030-6853 |
Second Address | Kent, WA 98030-6853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 19/04/2012 |