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Tracie L. Vestal Dds Pa
Dental Clinic/Center in Elizabethtown, North Carolina
NPI 1508039405

Tracie L. Vestal Dds Pa is a Dental Clinic/Center based in Elizabethtown, NC and is specialized in Dental. Tracie L. Vestal Dds Pa practices in Elizabethtown, NC. The NPI Number for Tracie L. Vestal Dds Pa is 1508039405 and holds a License No. 7200 (North Carolina).

The current practice location address for Tracie L. Vestal Dds Pa is 500 W Broad St, Elizabethtown, NC and can be reached out via phone at 910-862-4078.

Location: 500 W Broad St, Elizabethtown, NC, 28337-9411
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1508039405
Provider Name
Tracie L. Vestal Dds Pa
Credential
Provider Entity Type
Organization
Address
500 W Broad St, Elizabethtown, NC, 28337-9411
Phone Number
910-862-4078
Fax Number
Provider Enumeration Date
04/11/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
7200 01 NC NC LICENSE
902EC 01 NC BCBS PROVIDER #
89902EC 05 NC
institution
Provider Business Practice Location Address Details
Address
500 W Broad St
City
Elizabethtown
State
North Carolina
Zip
28337-9411
Phone Number
910-862-4078
Fax Number
person
Provider Business Mailing Address Details
Address
500 W Broad St
City
Elizabethtown
State
North Carolina
Zip
28337-9411
Phone Number
910-862-4078
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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