Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60612122 | WA |
NPI | 1306211479 |
---|---|
Provider Name | Oleksandr P Stasyuk |
First Address | Edmonds, WA 98026-8838 |
Second Address | Lynnwood, WA 98036-5052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2015 |
Last Update Date | 01/12/2015 |