Provider Demographics
NPI:1679976039
Name:SUNGA, TRACY REPANCOL (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:REPANCOL
Last Name:SUNGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 HARMON LOOP RD STE 208
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6535
Mailing Address - Country:US
Mailing Address - Phone:671-988-3235
Mailing Address - Fax:
Practice Address - Street 1:674 HARMON LOOP RD STE 208
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6535
Practice Address - Country:US
Practice Address - Phone:671-988-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD1022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist