Active NPI
Tracy H Takenaka, D.D.S.
- Pediatric Dentistry
- Dupont, WA
National Provider Identifier
1124005525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DE60023910
- Practice address
- 1200 Station Dr Ste 180
Dupont, WA 98327-9804 - Phone
- (253) 964-0150
- NPI assigned
- Dec 27, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 051468-1 | NY | |
| Pediatric Dentistry | 1223P0221X | DE60023910 | WA | Primary |
Addresses
Primary practice location
1200 Station Dr Ste 180
Dupont, WA 98327-9804
Mailing address
1200 Station Dr Ste 180
Dupont, WA 98327-9804
Phone (253) 964-0150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60023910 | WA | MD | Pediatric Dentist |
| 051468-1 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313020800000",
"number": "1124005525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 STATION DR STE 180",
"city": "DUPONT",
"state": "WA",
"postal_code": "983279804",
"telephone_number": "253-964-0150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 STATION DR STE 180",
"city": "DUPONT",
"state": "WA",
"postal_code": "983279804",
"telephone_number": "253-964-0150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKENAKA",
"first_name": "TRACY",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-27",
"last_updated": "2011-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "051468-1",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WA",
"license": "DE60023910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dupont, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.