Provider Demographics
NPI:1538498316
Name:RACKI, TROY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:ROBERT
Last Name:RACKI
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-0177
Mailing Address - Country:US
Mailing Address - Phone:530-275-1231
Mailing Address - Fax:
Practice Address - Street 1:2620 LARKSPUR LN STE P
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1043
Practice Address - Country:US
Practice Address - Phone:530-338-2500
Practice Address - Fax:530-338-2502
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57240OtherCA DENTAL LICENSE
CA57240OtherCA DENTAL LICENSE