Individual
TYKA L BRANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTDA ASSISTANT
Contact information
Practice address
14406 NE 20TH AVE, VANCOUVER, WA 98686-1448
(360) 571-3139
Mailing address
305 COWLITZ WAY, KELSO, WA 98626-4109
(360) 571-3139
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
0764
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0764
PTDA ASSISTANT @KP
WA
Enumeration date
08/17/2006
Last updated
07/08/2007
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