Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1043864127 |
---|---|
Provider Name | Traci Guan |
First Address | Lynnwood, WA 98087-8609 |
Second Address | Lynnwood, WA 98036-7073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2019 |
Last Update Date | 28/07/2019 |