| Tracie L. Vestal, Dds, Pa | |
|
1014b Grandiflora Dr Leland NC 28451-7454 | |
| (910) 371-5965 | |
| Not Available |
| Full Name | Tracie L. Vestal, Dds, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1014b Grandiflora Dr, Leland, North Carolina |
| Authorized Official Name and Position | Tracie Leigh Vestal (OWNER) |
| Authorized Official Contact | 9103715965 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracie L. Vestal, Dds, Pa 1014b Grandiflora Dr Leland NC 28451-7454 Ph: (910) 371-5965 | Tracie L. Vestal, Dds, Pa 1014b Grandiflora Dr Leland NC 28451-7454 Ph: (910) 371-5965 |
| NPI Number | 1356515639 |
|---|---|
| Provider Enumeration Date | 04/17/2008 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356515639 | NPI | - | NPPES |
| 7200 | Other | NC | DENTAL LICENSE # |
| 902EC | Other | NC | BCBS # |
| 89902EC | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 7200 (North Carolina) | Primary |
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