Active NPI
Tracy C Sullivan, DDS
- General Practice Dentistry
- Port Orchard, WA
National Provider Identifier
1275547101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE00008642
- Practice address
- 1880 Pottery Ave
Suite 200
Port Orchard, WA 98366-2518 - Phone
- (360) 895-4321
- Fax
- (360) 895-4326
- NPI assigned
- Jul 28, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00008642 | WA | Primary |
Addresses
Primary practice location
1880 Pottery Ave
Suite 200
Port Orchard, WA 98366-2518
Mailing address
1880 Pottery Ave
Suite 200
Port Orchard, WA 98366-2518
Phone (360) 895-4321
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 |
|---|---|---|---|
| DE00008642 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yoder, Grieser & Sullivan, DDS, LLP | Past | Accepting new patients | |
| Jae H Ha DDS PLLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Port Orchard, WA
- NPI 1669274122
-
- Dentist
- Port Orchard, WA
- NPI 1336346402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275547101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1880 POTTERY AVE",
"address_2": "SUITE 200",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983662518",
"telephone_number": "360-895-4321",
"fax_number": "360-895-4326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 POTTERY AVE",
"address_2": "SUITE 200",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983662518",
"telephone_number": "360-895-4321",
"fax_number": "360-895-4326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "TRACY",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00008642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orchard, WA
- Christina Rainwater Strode, L.M.P.
- Linda Strub-Andersen, LMT
- Mary Jo Stump, PTA
- Ginny E Sugimoto, M.D.
- James H Sullivan, PH.D.
- Danielle Summer, RN
- Summit Dental Lab
- Sunray Treatment and Recovery
- Susan Putaansuu, MN, Arnp, PLLC (Sound Mind & Health Psychiatric Services)
- Susan Putaansuu, MN, Arnp, Pmhnp-BC (Sound Mind & Health Psychiatric Services)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.