Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DE00008486 | WA |
NPI | 1285692475 |
---|---|
Provider Name | Richard Bass |
First Address | Spokane, WA 99201-0254 |
Second Address | Spokane, WA 99201-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179468 | L&I (01) | WA |
5025282 | (05) | WA |