Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN-60139787 | WA |
NPI | 1548760630 |
---|---|
Provider Name | Stephen Depirro II |
First Address | Alta Loma, CA 91737-2264 |
Second Address | Seaside, OR 97138-6603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2018 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN-60139787 | WASHINGTON STATE DEPARTMENT OF HEALTH (01) | WA |
DT-DO-10130609 | OREGON DEPARTMENT OF HEALTH (01) | OR |