Provider Demographics
NPI:1093849176
Name:MAYERS, TRACY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:MAYERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 BREEZEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3893
Mailing Address - Country:US
Mailing Address - Phone:419-225-7943
Mailing Address - Fax:
Practice Address - Street 1:2544 BREEZEWOOD LN
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3893
Practice Address - Country:US
Practice Address - Phone:419-225-7943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300209421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice