Provider Demographics
NPI:1689714263
Name:TRACY, DAVID J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:TRACY
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 1:1207 CARLSBAD VILLAGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1958
Mailing Address - Country:US
Mailing Address - Phone:760-434-4301
Mailing Address - Fax:760-434-6016
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR STE A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1958
Practice Address - Country:US
Practice Address - Phone:760-434-4301
Practice Address - Fax:760-434-6016
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery