Provider Demographics
NPI:1922669597
Name:TRACY FILLER, DMD, INC.
Entity Type:Organization
Organization Name:TRACY FILLER, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DAO
Authorized Official - Last Name:FILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-329-8922
Mailing Address - Street 1:1569 LEXANN DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-329-8922
Mailing Address - Fax:
Practice Address - Street 1:1569 LEXANN DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121
Practice Address - Country:US
Practice Address - Phone:408-329-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty