=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275867350
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY SYERS DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2009
-----------------------------------------------------
Last Update Date | 09/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 SUTTER ST 2005
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108-4206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-398-1017
-----------------------------------------------------
Fax | 415-398-1099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 SUTTER ST 2005
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-398-1017
-----------------------------------------------------
Fax | 415-398-1099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 49006
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------