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General NPI Number Information
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NPI Number | 1881140499
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Entity Type | Organization
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Legal Business Name | TRACY L. DELORM, D.D.S. PLLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 9514 4TH ST. NE UNIT 102
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City | LAKE STEVENS
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State | WA
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Zip | 98258
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Country | US
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Telephone | 425-334-4001
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Fax | 425-335-4003
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Provider Business Mailing Address
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Address Line | 9514 4TH ST NE UNIT 102
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City | LAKE STEVENS
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State | WA
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Zip | 98258-1937
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Country | US
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Telephone | 425-334-4001
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Fax | 425-335-4003
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Authorized Official
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Title or Position | DOCTOR
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Name | TRACY L. DELORM
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Credential | DDS
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Telephone | 425-334-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE9086
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License Number State | WA
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