Provider Demographics
NPI:1225254402
Name:ROBINSON, TRACY R (DMD, PC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:R
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-1389
Mailing Address - Country:US
Mailing Address - Phone:541-935-2113
Mailing Address - Fax:
Practice Address - Street 1:25078 HUNTER RD.
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487
Practice Address - Country:US
Practice Address - Phone:541-935-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice