Individual
MR. DEREK T PAWLAK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
161 BAY LYN DR, LYNDEN, WA 98264-9404
(360) 318-0880
(360) 318-0880
Mailing address
161 BAY LYN DR, LYNDEN, WA 98264-9404
(360) 318-0880
(360) 318-0880
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
025108DN00000270
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025108DN00000270
DEPT OF HEALTH
WA
05
—
5036017
—
WA
Enumeration date
09/13/2005
Last updated
07/08/2007
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