Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000332 | WA |
NPI | 1922179571 |
---|---|
Provider Name | Mr. Troy Jonathan Wendell |
First Address | Tacoma, WA 98402-1295 |
Second Address | Tacoma, WA 98402-1295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5040373 | DSHS OFFICE (01) | WA |
5040381 | DSHS TROY (01) | WA |