Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1821654450 |
---|---|
Provider Name | Vyacheslav P Zalyashko |
First Address | Vancouver, WA 98682-3745 |
Second Address | Vancouver, WA 98682-8289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2019 |
Last Update Date | 20/05/2019 |