Provider Demographics
NPI:1972937357
Name:TRACY, RONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
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 1:10315 19TH AVE SE STE 110
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4268
Mailing Address - Country:US
Mailing Address - Phone:425-337-1000
Mailing Address - Fax:425-337-1099
Practice Address - Street 1:10315 19TH AVENUE SE SUITE 110
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-337-1000
Practice Address - Fax:425-337-1099
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist