Provider Demographics
NPI:1316787138
Name:TRANQUIL TEETH LLC
Entity type:Organization
Organization Name:TRANQUIL TEETH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-525-4664
Mailing Address - Street 1:PO BOX L1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NE
Mailing Address - Zip Code:68446-0652
Mailing Address - Country:US
Mailing Address - Phone:402-269-3160
Mailing Address - Fax:402-269-3174
Practice Address - Street 1:935 1ST ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NE
Practice Address - Zip Code:68446-9612
Practice Address - Country:US
Practice Address - Phone:402-269-3160
Practice Address - Fax:402-269-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1548413784Medicaid
NE1346315777Medicaid