NPIMap

Organization Active NPI

Tracy Kirk DDS, PLLC

  • General Practice Dentistry
  • Ft Worth, TX
National Provider Identifier
1992249239
Registry record updated Oct 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
29655 Issued in TX
Legal business name
TRACY KIRK DDS, PLLC
Practice address
6300 N. Beach St
Ft Worth, TX 76137
Phone
(817) 281-3100
Fax
(817) 788-5984
NPI assigned
Dec 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2021

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

Authorized official

Name
Mrs. Jamie E Gomez
Title
Office Manager
Phone
(817) 281-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 29655 TX Primary

Addresses

Primary practice location

6300 N. Beach St
Ft Worth, TX 76137

Mailing address

6300 N. Beach St
Haltom City, TX 76137
Phone (817) 281-3100

Other names 1

  • Fossil Creek Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1480982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1992249239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 N. BEACH ST",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "76137",
            "telephone_number": "817-281-3100",
            "fax_number": "817-788-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N. BEACH ST",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "76137",
            "telephone_number": "817-281-3100",
            "fax_number": "817-788-5984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY KIRK DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-06",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "817-281-3100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "29655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fossil Creek Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fossil Creek Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ft Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.