| Organization Name: | TRACY H TAKENAKA DDS MSD PS |
| NPI Number: | 1144567504 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACY H TAKENAKA (OWNER/DENTIST) |
| Mailing Address: | 1200 Station Dr Ste 180 Dupont |
| State: | WA US |
| Postal Code: | 983279804 |
| Phone Number: | 2539640150 |
| Fax Number: | 2539649830 |
| NPI Enumeration Date: | 01/04/2013 |
| NPI Last Update Date: | 01/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DE60023910 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |