Provider Demographics
NPI:1003254814
Name:MORALES, TRACY RENEE' (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:RENEE'
Last Name:MORALES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:RENEE'
Other - Last Name:ELIZALDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3906
Mailing Address - Country:US
Mailing Address - Phone:713-869-4085
Mailing Address - Fax:713-869-6414
Practice Address - Street 1:310 W 19TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3906
Practice Address - Country:US
Practice Address - Phone:713-869-4085
Practice Address - Fax:713-869-6414
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist