NPIMap

Organization Active NPI

Tracy J. Waters, DDS., PA

  • General Practice Dentistry
  • Durham, NC
National Provider Identifier
1285704510
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7337 Issued in NC
Legal business name
TRACY J. WATERS, DDS., PA
Practice address
4210 N Roxboro St
Suite 100
Durham, NC 27704-1826
Phone
(919) 620-6700
Fax
(919) 620-7360
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tracy J. Waters, DDS, PANPI 1871681494
Title
President
Phone
(919) 620-6700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7337 NC Primary

Addresses

Primary practice location

4210 N Roxboro St
Suite 100
Durham, NC 27704-1826

Mailing address

4210 N Roxboro St
Suite 100
Durham, NC 27704-1826
Phone (919) 620-6700

Other identifiers 1

IdentifierTypeStateIssuer
89016JFMedicaidNC

Other names 1

  • Carolina Smiles Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

4210 N Roxboro St
Ste 100
Durham, NC 27704
Phone (919) 620-6700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1285704510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 N ROXBORO ST",
            "address_2": "SUITE 100",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277041826",
            "telephone_number": "919-620-6700",
            "fax_number": "919-620-7360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 N ROXBORO ST",
            "address_2": "SUITE 100",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277041826",
            "telephone_number": "919-620-6700",
            "fax_number": "919-620-7360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY J. WATERS, DDS., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "WATERS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-620-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, PA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016JF",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Smiles Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.