Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000196 | WA |
NPI | 1790007714 |
---|---|
Provider Name | Mr. Patrick C. Grant |
First Address | Tacoma, WA 98409-5911 |
Second Address | Tacoma, WA 98409-5911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2010 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5025085 | (05) | WA |