Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60186881 | WA |
NPI | 1992056634 |
---|---|
Provider Name | Ms. Alexandra Garland |
First Address | Hoodsport, WA 98548 |
Second Address | Shelton, WA 98584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2012 |
Last Update Date | 20/09/2012 |