Provider Demographics
NPI:1194907196
Name:TRACY D NGO D.D.S. INC
Entity type:Organization
Organization Name:TRACY D NGO D.D.S. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-591-8895
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty