Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4335 | WA |
NPI | 1003814781 |
---|---|
Provider Name | Rolf Melker Edlund |
First Address | Sumner, WA 98390-1501 |
Second Address | Sumner, WA 98390-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 08/07/2007 |