Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00001697 | WA |
N | 126800000X | Dental Assistant | D2 60156655 | WA |
NPI | 1174059604 |
---|---|
Provider Name | Roberta Byrd-Wright |
First Address | Seattle, WA 98144-2712 |
Second Address | Seattle, WA 98144-2712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2017 |
Last Update Date | 03/05/2017 |