Individual provider · NPI-1

Tracey King

Dental Assistant · Lynwood, CA

NPI number1164055125
StatusActive
Last updated in NPPESFeb 18, 2020

Details

NPI
1164055125
Entity type
Individual (NPI-1)
Name
Tracey King
Sex
Female
Sole proprietor
Yes
Enumeration date
Feb 18, 2020
Certification date
Feb 18, 2020
Last updated
Feb 18, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
126800000X Dental Assistant––Yes

Practice location

12617 Waldorf Dr
Lynwood, CA 90262-5233

Phone 323-690-7853

Mailing address

12617 Waldorf Dr
Lynwood, CA 90262-5233

Phone 323-690-7853

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