Provider Demographics
NPI:1003956384
Name:TRACY, COLLEEN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:A
Last Name:TRACY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 19TH AVE SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4268
Mailing Address - Country:US
Mailing Address - Phone:425-337-1000
Mailing Address - Fax:425-337-1099
Practice Address - Street 1:10315 19TH AVE SE
Practice Address - Street 2:SUITE 110
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4268
Practice Address - Country:US
Practice Address - Phone:425-337-1000
Practice Address - Fax:425-337-1099
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA65111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice