Individual
TAMMY LYNN BRACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1504 W ORCHARD AVE, SELAH, WA 98942-1296
(509) 949-0502
Mailing address
1504 W ORCHARD AVE, SELAH, WA 98942-1296
(509) 949-0502
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH00006436
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH00006436
RDH LICENSE NUMBER
WA
Enumeration date
11/07/2015
Last updated
11/07/2015
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