Individual
ANNETTE ALLISON TACKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
115 KIRKLAND RD, LONGVIEW, WA 98632-0701
(253) 653-0042
Mailing address
115 KIRKLAND RD, LONGVIEW, WA 98632-0701
(253) 653-0042
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH00007476
WA
Other
Enumeration date
12/29/2012
Last updated
12/29/2012
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