Provider Demographics
NPI:1336468560
Name:LAW, TRACY GUY (DDS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:GUY
Last Name:LAW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 W VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7086
Mailing Address - Country:US
Mailing Address - Phone:559-734-4918
Mailing Address - Fax:
Practice Address - Street 1:136 S ASPEN CT
Practice Address - Street 2:STE B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5175
Practice Address - Country:US
Practice Address - Phone:559-625-9300
Practice Address - Fax:559-625-9330
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice