Provider Demographics
NPI:1194886523
Name:TRACY, VON R (DDS)
Entity type:Individual
Prefix:
First Name:VON
Middle Name:R
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 1:10121 N NEVADA
Mailing Address - Street 2:201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218
Mailing Address - Country:US
Mailing Address - Phone:509-466-6614
Mailing Address - Fax:509-466-0982
Practice Address - Street 1:10121 N NEVADA
Practice Address - Street 2:201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-466-6614
Practice Address - Fax:509-466-0982
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice