Healthcare Provider Details

I. General information

NPI: 1487434908
Provider Name (Legal Business Name): DR TRACY REPANCOL SUNGA DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 HARMON LOOP RD STE 208
DEDEDO GU
96929-6535
US

IV. Provider business mailing address

674 HARMON LOOP RD STE 208
DEDEDO GU
96929-6535
US

V. Phone/Fax

Practice location:
  • Phone: 671-988-3235
  • Fax:
Mailing address:
  • Phone: 671-633-8243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY REPANCOL SUNGA
Title or Position: OWNER
Credential: DDS
Phone: 671-988-3235