Provider Demographics
NPI:1548413784
Name:GARCIA, TRACY NICOLE (MFS, DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:NICOLE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MFS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 STOCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5755
Mailing Address - Country:US
Mailing Address - Phone:402-421-7500
Mailing Address - Fax:402-421-7715
Practice Address - Street 1:2623 STOCKWELL ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-5755
Practice Address - Country:US
Practice Address - Phone:402-525-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist