NPIMap

Organization Active NPI

Dr. Robert E. Tracy D.D.S., P.S.

  • Dental Clinic/Center
  • Seattle, WA
National Provider Identifier
1962647578
Registry record updated Dec 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
4990 Issued in WA
Legal business name
DR. ROBERT E. TRACY D.D.S., P.S.
Practice address
11066 5TH Ave NE
Suite 200
Seattle, WA 98125-6156
Phone
(206) 362-3833
Fax
(206) 362-3834
NPI assigned
Dec 10, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2008

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

Authorized official

Name
Dr. Robert E. Tracy, D.D.S., P.S.NPI 1447304019
Title
Sole Proprietor
Phone
(206) 362-3833

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 4990 WA Primary

Addresses

Primary practice location

11066 5TH Ave NE
Suite 200
Seattle, WA 98125-6156

Mailing address

11066 5TH Ave NE
Suite 200
Seattle, WA 98125-6156
Phone (206) 362-3833

Other identifiers 3

IdentifierTypeStateIssuer
4990OtherWALISCENCE
5002043OtherWAMEDICAID
970226OtherWAUNITED CONCORDIA PROVIDER ID

National Provider Directory

National Provider Directory

Locations

11066 5th Ave NE
Ste 200
Seattle, WA 98125
Phone (206) 362-3833

Practitioners & affiliated clinicians

Practitioners 1

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": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1962647578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11066 5TH AVE NE",
            "address_2": "SUITE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981256156",
            "telephone_number": "206-362-3833",
            "fax_number": "206-362-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11066 5TH AVE NE",
            "address_2": "SUITE 200",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981256156",
            "telephone_number": "206-362-3833",
            "fax_number": "206-362-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ROBERT E. TRACY D.D.S., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-10",
        "last_updated": "2008-12-10",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "206-362-3833",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., P.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "4990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCENCE",
            "identifier": "4990",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "5002043",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA PROVIDER ID",
            "identifier": "970226",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; 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.