Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000134 | WA |
NPI | 1558582825 |
---|---|
Provider Name | Mr. Vallan T Charron |
First Address | Tacoma, WA 98402-3705 |
Second Address | Tacoma, WA 98402-3705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |