Provider Demographics
NPI:1023360310
Name:TRACEY TABOR WILLIAMS, DMD, PC
Entity Type:Organization
Organization Name:TRACEY TABOR WILLIAMS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEBASTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-637-4636
Mailing Address - Street 1:303 N ALABAMA ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2037
Mailing Address - Country:US
Mailing Address - Phone:317-637-4636
Mailing Address - Fax:
Practice Address - Street 1:303 N ALABAMA ST
Practice Address - Street 2:SUITE 270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2037
Practice Address - Country:US
Practice Address - Phone:317-637-4636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty