Provider Demographics
NPI:1235582602
Name:NPD SERVICE LLC
Entity Type:Organization
Organization Name:NPD SERVICE LLC
Other - Org Name:VON R. TRACY DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VON
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-466-6614
Mailing Address - Street 1:8404 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6171
Mailing Address - Country:US
Mailing Address - Phone:509-466-6614
Mailing Address - Fax:509-466-0982
Practice Address - Street 1:8404 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6171
Practice Address - Country:US
Practice Address - Phone:509-466-6614
Practice Address - Fax:509-466-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6885261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental