| Tracy Nicole Dds A Professional Dental Corporation | |
|
330 Park Ave Suite 1 Laguna Beach CA 92657 | |
| (949) 497-3397 | |
| (949) 497-0227 |
| Full Name | Tracy Nicole Dds A Professional Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 330 Park Ave, Laguna Beach, California |
| Authorized Official Name and Position | Tracy Nicole (OWNER PRESIDENT OF CORP) |
| Authorized Official Contact | 9494973397 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tracy Nicole Dds A Professional Dental Corporation 330 Park Ave Suite 1 Laguna Beach CA 92657 Ph: (949) 497-3397 | Tracy Nicole Dds A Professional Dental Corporation 330 Park Ave Suite 1 Laguna Beach CA 92657 Ph: (949) 497-3397 |
| NPI Number | 1306950340 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306950340 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 45231 (California) | Primary |
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