Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 713 | WA |
NPI | 1336241157 |
---|---|
Provider Name | Mrs. Alesha Diane Mosher |
First Address | Vancouver, WA 98682-2475 |
Second Address | Vancouver, WA 98684-6053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |