Individual
MS. TRACI WASIATH ELISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4315 DIPLOMACY DR, ANCHORAGE, AK 99508-5926
(907) 563-2662
(907) 563-2662
Mailing address
11301 WOOD RIVER WAY, EAGLE RIVER, AK 99577-7314
(406) 202-1920
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1502
AK
122300000X
Dentist
DE 60284737
WA
122300000X
Dentist
DEN-DEN-LIC-4169
MT
Other
Enumeration date
04/25/2011
Last updated
08/10/2013
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