Organization
DR. ROBERT E. TRACY D.D.S., P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT E. TRACY D.D.S., P.S. (SOLE PROPRIETOR)
(206) 362-3833
Entity
Organization
Contact information
Practice address
11066 5TH AVE NE, SUITE 200, SEATTLE, WA 98125-6156
(206) 362-3833
(206) 362-3834
Mailing address
11066 5TH AVE NE, SUITE 200, SEATTLE, WA 98125-6156
(206) 362-3833
(206) 362-3834
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4990
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4990
LISCENCE
WA
01
—
5002043
MEDICAID
WA
01
—
970226
UNITED CONCORDIA PROVIDER ID
WA
Enumeration date
12/10/2008
Last updated
12/10/2008
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