Tracy L. Delorm, D.D.S. PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

DE9086 Issued in WA

Legal business name

TRACY L. DELORM, D.D.S. PLLC

Practice address

9514 4TH St. NE Unit 102
Lake Stevens, WA 98258

Phone

(425) 334-4001

Fax

(425) 335-4003

NPI assigned

Sep 1, 2016

Organization subpart

No

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

Authorized official

Name

Tracy L. Delorm, DDS

Title

Doctor

Phone

(425) 334-4001

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DeLorm Family Dental Doing business as

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1881140499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9514 4TH ST NE UNIT 102",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982581937",
            "telephone_number": "425-334-4001",
            "fax_number": "425-335-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9514 4TH ST. NE UNIT 102",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "98258",
            "telephone_number": "425-334-4001",
            "fax_number": "425-335-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY L. DELORM, D.D.S. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "DELORM",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "425-334-4001",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE9086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501627465",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeLorm Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.