Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00004168 | WA |
NPI | 1013244839 |
---|---|
Provider Name | Richard Jury |
First Address | Springdale, WA 99173-0429 |
Second Address | Springdale, WA 99173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2009 |
Last Update Date | 16/11/2009 |