Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000466 | WA |
NPI | 1467648105 |
---|---|
Provider Name | Ryan D Johnson |
First Address | Prosser, WA 99350-1423 |
Second Address | Prosser, WA 99350-1423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2007 |
Last Update Date | 17/09/2007 |