Healthcare Provider Details

I. General information

NPI: 1457360034
Provider Name (Legal Business Name): VICKI BREAKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 44TH STREET
TACOMA WA
98404
US

IV. Provider business mailing address

1019 PACIFIC AVE STE. 300
TACOMA WA
98402-4443
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-7002
  • Fax: 253-593-2854
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00005989
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: