Provider Demographics
NPI:1700050325
Name:RONALD J TRACY DDS, PS
Entity Type:Organization
Organization Name:RONALD J TRACY DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-863-2995
Mailing Address - Street 1:1006 FRYAR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1501
Mailing Address - Country:US
Mailing Address - Phone:253-863-2995
Mailing Address - Fax:253-863-3821
Practice Address - Street 1:1006 FRYAR AVE STE B
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1501
Practice Address - Country:US
Practice Address - Phone:253-863-2995
Practice Address - Fax:253-863-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4141261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5307202Medicaid