Provider Demographics
NPI:1588799084
Name:CREAR, TRACY MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MANUEL
Last Name:CREAR
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 1:3508 GROOM RD
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3508
Mailing Address - Country:US
Mailing Address - Phone:225-374-3934
Mailing Address - Fax:225-374-9980
Practice Address - Street 1:3508 GROOM RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3508
Practice Address - Country:US
Practice Address - Phone:225-374-3934
Practice Address - Fax:225-374-9980
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1845418Medicaid