Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000367 | WA |
NPI | 1306902929 |
---|---|
Provider Name | William S. Disantis |
First Address | Yakima, WA 98902-3293 |
Second Address | Yakima, WA 98902-3293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5048293 | (05) | WA |
DN00000367 | LICENSE NUMBER (01) | WA |