Healthcare Provider Details

I. General information

NPI: 1356374060
Provider Name (Legal Business Name): TRACY ALLAN QUICKSTAD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18122 STATE ROUTE 9 SE SUITE C
SNOHOMISH WA
98296-5384
US

IV. Provider business mailing address

18122 STATE ROUTE 9 SE SUITE C
SNOHOMISH WA
98296-5384
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-2384
  • Fax: 425-486-2358
Mailing address:
  • Phone: 425-485-2384
  • Fax: 425-486-2358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5961
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: