Provider Demographics
NPI:1649573759
Name:HARRIS, TRACY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WAYNE AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4450
Mailing Address - Country:US
Mailing Address - Phone:301-589-0518
Mailing Address - Fax:301-589-0504
Practice Address - Street 1:801 WAYNE AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4450
Practice Address - Country:US
Practice Address - Phone:301-589-0518
Practice Address - Fax:301-589-0504
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103151223G0001X
DCDEN51061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice