Provider Demographics
NPI:1376797779
Name:EICHSTADT, TRACI LYN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:LYN
Last Name:EICHSTADT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14145 SW PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9300
Mailing Address - Country:US
Mailing Address - Phone:503-709-0436
Mailing Address - Fax:
Practice Address - Street 1:14145 SW PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-9300
Practice Address - Country:US
Practice Address - Phone:503-709-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3428124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist