Provider Demographics
NPI:1952421919
Name:NGO, TRACY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:NGO
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 1:12411 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2604
Mailing Address - Country:US
Mailing Address - Phone:909-591-8895
Mailing Address - Fax:909-591-3503
Practice Address - Street 1:12411 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2604
Practice Address - Country:US
Practice Address - Phone:909-591-8895
Practice Address - Fax:909-591-3503
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice