# TRACY L. DELORM, D.D.S. PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DeLorm Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881140499
- **Authorized official:** TRACY L. DELORM DDS (DOCTOR)
- **Authorized official phone:** (425) 334-4001

## Contact information

- **Practice address:** 9514 4TH ST. NE UNIT 102, LAKE STEVENS, WA 98258
- **Practice address phone:** (425) 334-4001
- **Practice address fax:** (425) 335-4003
- **Mailing address:** 9514 4TH ST NE UNIT 102, LAKE STEVENS, WA 98258-1937
- **Mailing address phone:** (425) 334-4001
- **Mailing address fax:** (425) 335-4003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE9086 | WA | Yes |

## Other

- **Enumeration date:** 09/01/2016
- **Last updated:** 09/01/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 501627465 | — | WA |