Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000194 | WA |
NPI | 1740602176 |
---|---|
Provider Name | Patrick Carbone |
First Address | Olympia, WA 98506-5080 |
Second Address | Olympia, WA 98506-5080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2014 |
Last Update Date | 21/01/2014 |