Healthcare Provider Details

I. General information

NPI: 1811155187
Provider Name (Legal Business Name): TRACY DAO FILLER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2593 S KING RD STE 3
SAN JOSE CA
95122-1880
US

IV. Provider business mailing address

2593 S KING RD STE 3
SAN JOSE CA
95122-1880
US

V. Phone/Fax

Practice location:
  • Phone: 408-345-5609
  • Fax: 408-256-7540
Mailing address:
  • Phone: 408-240-0250
  • Fax: 323-249-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: