Park, Tracy S
Park, Tracy S is an individual health care provider with primary practice located at 2760 3Rd Street Suite A, Ceres CA 95307. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Park, Tracy S can be contacted via phone (209) 537-4427.Contact Information
Primary practice address
2760 3Rd Street Suite A
Ceres CA 95307
Phone: (209) 537-4427
Fax: (209) 537-4437
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 41769 | California |
Profile Details
| NPI number | 1073615084 |
|---|---|
| LBN Legal business name | Park, Tracy S |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 1st, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073615084 | NPPES |
| California | Other | B4176901 | DENTI-CAL |
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