Individual
DR. ROBERT E. TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., P.S.
Contact information
Practice address
11066 5TH AVE NE, SUITE 200, SEATTLE, WA 98125-6156
(206) 362-3833
Mailing address
11066 5TH AVE NE, SUITE 200, SEATTLE, WA 98125-6156
(206) 362-3833
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00004990
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4990
LICENSE
WA
05
—
5002043
—
WA
01
—
91-1188334
TAX ID #
WA
01
—
970226
UNITED CONCORDIA ID
WA
Enumeration date
01/22/2007
Last updated
12/10/2008
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