Provider Demographics
NPI:1750748380
Name:BACA, CECILIA (RDH)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BACA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:V
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:10521 MERIDIAN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9509
Practice Address - Country:US
Practice Address - Phone:206-296-4990
Practice Address - Fax:206-205-5142
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006117124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist