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Tracie L. Vestal, Dds, Pa
Dental Clinic/Center in Leland, North Carolina
NPI 1356515639

Tracie L. Vestal, Dds, Pa is a Dental Clinic/Center based in Leland, NC and is specialized in Dental. Tracie L. Vestal, Dds, Pa practices in Leland, NC. The NPI Number for Tracie L. Vestal, Dds, Pa is 1356515639 and holds a License No. 7200 (North Carolina).

The current practice location address for Tracie L. Vestal, Dds, Pa is 1014B Grandiflora Dr, Leland, NC and can be reached out via phone at 910-371-5965.

Location: 1014B Grandiflora Dr, Leland, NC, 28451-7454
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1356515639
Provider Name
Tracie L. Vestal, Dds, Pa
Credential
Provider Entity Type
Organization
Address
1014B Grandiflora Dr, Leland, NC, 28451-7454
Phone Number
910-371-5965
Fax Number
Provider Enumeration Date
04/17/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
7200 01 NC DENTAL LICENSE #
902EC 01 NC BCBS #
89902EC 05 NC
institution
Provider Business Practice Location Address Details
Address
1014B Grandiflora Dr
City
Leland
State
North Carolina
Zip
28451-7454
Phone Number
910-371-5965
Fax Number
person
Provider Business Mailing Address Details
Address
1014B Grandiflora Dr
City
Leland
State
North Carolina
Zip
28451-7454
Phone Number
910-371-5965
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
7200 (North Carolina)
Definition
Definition to come...
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