Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 2901019629 | MI |
Y | 1223P0221X | Pediatric Dentist | 2901019629 | MI |
NPI | 1104026624 |
---|---|
Provider Name | Tracy E Davies |
First Address | Flint, MI 48503-2465 |
Second Address | Flint, MI 48503-2465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 09/11/2012 |