Provider Demographics
NPI:1144378589
Name:FURGESS, TRACIE SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:SMITH
Last Name:FURGESS
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:PO BOX 1461
Mailing Address - Street 2:1330 GREGG STREET
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-1461
Mailing Address - Country:US
Mailing Address - Phone:803-254-1911
Mailing Address - Fax:803-254-7120
Practice Address - Street 1:1330 GREGG ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3526
Practice Address - Country:US
Practice Address - Phone:803-254-1911
Practice Address - Fax:803-254-7120
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ35784Medicaid