Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 604719821 | WA |
NPI | 1164091302 |
---|---|
Provider Name | Robert E Estes |
First Address | Ellensburg, WA 98926-3369 |
Second Address | Ellensburg, WA 98926-3369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |