Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DE61007218 | WA |
NPI | 1063056711 |
---|---|
Provider Name | Peeyush Ranjan |
First Address | Longview, WA 98632-3929 |
Second Address | Longview, WA 98632-3929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 05/11/2019 |