Active NPI
Tracy Lynn Provenghi, DDS
- General Practice Dentistry
- El Paso, TX
National Provider Identifier
1447305156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 16456
- Practice address
- 7400 Viscount Blvd
Suite 210
El Paso, TX 79925-4851 - Phone
- (915) 772-4740
- Fax
- (915) 772-4853
- NPI assigned
- Jan 24, 2007
- 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 | 16456 | TX | Primary |
Addresses
Primary practice location
7400 Viscount Blvd
Suite 210
El Paso, TX 79925-4851
Mailing address
7400 Viscount Blvd
Suite 210
El Paso, TX 79925-4828
Phone (915) 772-4740
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 |
|---|---|---|---|
| 16456 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447305156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7400 VISCOUNT BLVD",
"address_2": "SUITE 210",
"city": "EL PASO",
"state": "TX",
"postal_code": "799254828",
"telephone_number": "915-772-4740",
"fax_number": "915-772-4853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7400 VISCOUNT BLVD",
"address_2": "SUITE 210",
"city": "EL PASO",
"state": "TX",
"postal_code": "799254851",
"telephone_number": "915-772-4740",
"fax_number": "915-772-4853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVENGHI",
"first_name": "TRACY",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "16456",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Paso, TX
- Provedoras Caseras de El Paso Inc.
- Proveedoras de Luz Home Health, LLC
- Provencio Enterprises Incorporated
- Provencio Enterprises Incorporated
- Mauro Provencio, M.D.
- Providence Imaging Consultants, P.a.
- Providence Service Corporation
- Provident Eye Specialists, PA
- Jessica Estelle Provine
- Provision Home Care Agency LLC
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.