Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN0130 | WA |
NPI | 1598704033 |
---|---|
Provider Name | Thomas Albert Bohna |
First Address | Vancouver, WA 98682-7418 |
Second Address | Vancouver, WA 98682-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5025259 | (05) | WA |