Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN60869847 | WA |
NPI | 1245795525 |
---|---|
Provider Name | Ruslan Galushkin |
First Address | Everett, WA 98201-4200 |
Second Address | Everett, WA 98201-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 31/01/2019 |