Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000200 | WA |
NPI | 1104971241 |
---|---|
Provider Name | Siony F Tabanda |
First Address | Renton, WA 98055-2400 |
Second Address | Renton, WA 98055-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5027131 | (05) | WA |