Provider Demographics
NPI:1568568814
Name:SCHILLING-HYSJULIEN, TRACEY LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:LEIGH
Last Name:SCHILLING-HYSJULIEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TRACEY
Other - Middle Name:LEIGH
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6513 PROMONTORY DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1916
Mailing Address - Country:US
Mailing Address - Phone:952-937-5598
Mailing Address - Fax:
Practice Address - Street 1:6601 LYNDALE AVE S
Practice Address - Street 2:STE 230
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2477
Practice Address - Country:US
Practice Address - Phone:612-866-1234
Practice Address - Fax:612-638-1232
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice