Provider Demographics
NPI:1598904872
Name:VANBLARGEN, TRACY CALVIN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:CALVIN
Last Name:VANBLARGEN
Suffix:I
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 1:451 W GONZALES RD STE 360
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0734
Mailing Address - Country:US
Mailing Address - Phone:805-988-4050
Mailing Address - Fax:805-988-3392
Practice Address - Street 1:451 W GONZALES RD STE 360
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0734
Practice Address - Country:US
Practice Address - Phone:805-988-4050
Practice Address - Fax:805-988-3392
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist