NPIMap

Organization Active NPI

Tracy Park D.D.S. a Professional Corporation

  • Dentist
  • Ceres, CA
National Provider Identifier
1710246798
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TRACY PARK D.D.S. A PROFESSIONAL CORPORATION
Practice address
2760 3Rd Street
Suite a
Ceres, CA 95307-3220
Phone
(209) 537-4427
Fax
(209) 537-4437
NPI assigned
May 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Authorized official

Name
Mrs. Tracy Sun ParkNPI 1073615084
Title
Dentist/Owner
Phone
(209) 537-4427

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary
Dental Clinic/Center 261QD0000X 41769 CA

Addresses

Primary practice location

2760 3Rd Street
Suite a
Ceres, CA 95307-3220

Mailing address

2760 3Rd Street
Suite a
Ceres, CA 95307-3220
Phone (209) 537-4427

National Provider Directory

National Provider Directory

Locations

2760 3rd St
Ste A
Ceres, CA 95307
Phone (209) 537-4427

Practitioners & affiliated clinicians

Practitioners 2

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": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1710246798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 3RD STREET",
            "address_2": "SUITE A",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953073220",
            "telephone_number": "209-537-4427",
            "fax_number": "209-537-4437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 3RD STREET",
            "address_2": "SUITE A",
            "city": "CERES",
            "state": "CA",
            "postal_code": "953073220",
            "telephone_number": "209-537-4427",
            "fax_number": "209-537-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY PARK D.D.S. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "SUN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "209-537-4427",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "41769",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ceres, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; 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.