Individual provider Active NPI

Tracy Dao Filler, DMD

  • General Practice Dentistry
  • San Jose, CA
National Provider Identifier
1811155187
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
53511 Issued in CA
Practice address
2593 S King Rd Ste 3
San Jose, CA 95122-1880
Phone
(408) 345-5609
Fax
(408) 256-7540
NPI assigned
May 23, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 53511 CA Primary

Addresses

Primary practice location

2593 S King Rd Ste 3
San Jose, CA 95122-1880

Mailing address

2593 S King Rd Ste 3
San Jose, CA 95122-1880
Phone (408) 240-0250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151231001771 CA Order and Referring Only - DentistPractitioner - Dentist 0143522508

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Western Dental Service, Inc Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1811155187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2593 S KING RD STE 3",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221880",
            "telephone_number": "408-240-0250",
            "fax_number": "323-249-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2593 S KING RD STE 3",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951221880",
            "telephone_number": "408-345-5609",
            "fax_number": "408-256-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FILLER",
        "first_name": "TRACY",
        "middle_name": "DAO",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-23",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.