Provider Demographics
NPI:1558156935
Name:GRACIA, SARAH ELIZA RUTH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZA RUTH
Last Name:GRACIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3328
Mailing Address - Country:US
Mailing Address - Phone:206-434-2153
Mailing Address - Fax:
Practice Address - Street 1:14100 SE 36TH ST STE 125
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1657
Practice Address - Country:US
Practice Address - Phone:206-767-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033300124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist