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General NPI Number Information
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NPI Number | 1174989339
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Entity Type | Individual
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Provider Name | TACY LYN SELLS I RDA
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Gender | Female
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 17425 HIGHWAY 99
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City | LYNNWOOD
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State | WA
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Zip | 98037-3101
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Country | US
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Telephone | 425-409-2105
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Fax |
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Provider Business Mailing Address
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Address Line | 9621 WOODS PL
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City | SNOHOMISH
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State | WA
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Zip | 98296-7128
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Country | US
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Telephone | 206-326-0611
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | D1 60052961
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License Number State | WA
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