Provider Demographics
NPI:1114921475
Name:SULC, TRACY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LYNN
Last Name:SULC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSSROADS DR
Mailing Address - Street 2:STE 106
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5419
Mailing Address - Country:US
Mailing Address - Phone:866-451-7794
Mailing Address - Fax:
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:STE 106
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:866-451-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice