Provider Demographics
NPI:1578678736
Name:WILLIAMS, TRACEY TABOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:TABOR
Last Name:WILLIAMS
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 1:303 N ALABAMA ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-2037
Mailing Address - Country:US
Mailing Address - Phone:317-637-4636
Mailing Address - Fax:317-637-4403
Practice Address - Street 1:303 N ALABAMA ST
Practice Address - Street 2:SUITE 270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2037
Practice Address - Country:US
Practice Address - Phone:317-637-4636
Practice Address - Fax:317-637-4403
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010679A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice