Tracy Dirk Sapp, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12009042 Issued in IN

Practice address

416 W Camp St
Lebanon, IN 46052-1799

Phone

(765) 483-4469

Fax

(765) 483-4495

NPI assigned

May 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Boone County Community Health Clinic, Inc

  • Community Health Clinic/Center
  • Lebanon, IN
  • NPI 1962681734
  NPD
• Monrovia Dental Clinic, LLC

  • Dental Clinic/Center
  • Monrovia, IN
  • NPI 1134401144
  NPD (past)
• Riggs Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Lafayette, IN
  • NPI 1386876233
  NPD (past)

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1902864804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1716 HARTFORD ST",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042138",
            "telephone_number": "765-742-1567",
            "fax_number": "765-429-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 W CAMP ST",
            "city": "LEBANON",
            "state": "IN",
            "postal_code": "460521799",
            "telephone_number": "765-483-4469",
            "fax_number": "765-483-4495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1324 Tippecanoe St",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479042051",
            "country_code": "US",
            "telephone_number": "765-742-1567",
            "fax_number": "765-429-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAPP",
        "first_name": "TRACY",
        "middle_name": "DIRK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100186680A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Rosenblum, RBT
• Darrah Roys
• Katlin C. Rutherford, MSN, APRN, FNP-C
• Megan Ruvolo, MSW,LCSW
• John Jacob Saalwaechter, M.D.
• Mojgan Sarmadi, M.D.
• Amber Leigh Schenck, MSW, LCSW
• Zachary Schenetzke, LMHC
• Sarah Elizabeth Schiferl, NP
• Joseph Eugene Schrier, RPH

• Dentist in Lebanon, IN
• Providers in Lebanon, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; 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.