Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | LD-39 | ID |
NPI | 1699903674 |
---|---|
Provider Name | William Joseph Harris |
First Address | Franklin, ID 83237-5094 |
Second Address | Franklin, ID 83237-5115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2009 |
Last Update Date | 29/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001863100 | (05) | ID |