Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000199 | WA |
NPI | 1306970801 |
---|---|
Provider Name | Peter Nabegh N Ghattas |
First Address | Puyallup, WA 98372-3167 |
Second Address | Puyallup, WA 98372-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5027412 | (05) | WA |