Provider Demographics
NPI:1730425919
Name:TRACY S OLIVER DDS PC
Entity type:Organization
Organization Name:TRACY S OLIVER DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-471-5480
Mailing Address - Street 1:2484 N LANDING RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3405
Mailing Address - Country:US
Mailing Address - Phone:757-471-5480
Mailing Address - Fax:757-471-7859
Practice Address - Street 1:2484 N LANDING RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3405
Practice Address - Country:US
Practice Address - Phone:757-471-5480
Practice Address - Fax:757-471-7859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401007137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty