Individual
GLEB DESNITSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6226 196TH ST SW STE 2D, LYNNWOOD, WA 98036-5959
(425) 286-5614
Mailing address
20818 59TH PL W, LYNNWOOD, WA 98036-7502
(425) 776-3617
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
60230490
WA
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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