Provider Demographics
NPI:1477742682
Name:GAY, TRACY WAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:WAYNE
Last Name:GAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2955
Mailing Address - Country:US
Mailing Address - Phone:478-272-1933
Mailing Address - Fax:478-275-7973
Practice Address - Street 1:1908 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2955
Practice Address - Country:US
Practice Address - Phone:478-272-1933
Practice Address - Fax:478-275-7973
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0123541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice