Provider Demographics
NPI:1639487663
Name:TRACY H TAKENAKA, DDS,MSD,PLLC
Entity Type:Organization
Organization Name:TRACY H TAKENAKA, DDS,MSD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:HARUKO
Authorized Official - Last Name:TAKENAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-742-9294
Mailing Address - Street 1:1200 STATION DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9804
Mailing Address - Country:US
Mailing Address - Phone:360-915-7321
Mailing Address - Fax:
Practice Address - Street 1:1200 STATION DR
Practice Address - Street 2:SUITE 180
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9804
Practice Address - Country:US
Practice Address - Phone:360-915-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600239101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty