| Tracy Park D.D.S. a Professional Corporation | |
|
2760 3rd Street Suite A Ceres CA 95307-3220 | |
| (209) 537-4427 | |
| (209) 537-4437 |
| Full Name | Tracy Park D.D.S. a Professional Corporation |
|---|---|
| Speciality | Dentist |
| Location | 2760 3rd Street, Ceres, California |
| Authorized Official Name and Position | Tracy Sun Park (DENTIST/OWNER) |
| Authorized Official Contact | 2095374427 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy Park D.D.S. a Professional Corporation 2760 3rd Street Suite A Ceres CA 95307-3220 Ph: (209) 537-4427 | Tracy Park D.D.S. a Professional Corporation 2760 3rd Street Suite A Ceres CA 95307-3220 Ph: (209) 537-4427 |
| NPI Number | 1710246798 |
|---|---|
| Provider Enumeration Date | 05/10/2012 |
| Last Update Date | 08/03/2021 |
| Certification Date | 08/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710246798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 41769 (California) | Secondary |
| 122300000X | Dentist | (NU) | Primary |
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