Provider Demographics
NPI:1598996597
Name:ECKLES, TRACY MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MICHELLE
Last Name:ECKLES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:MICHELLE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3605 LONGFORD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3250
Mailing Address - Country:US
Mailing Address - Phone:850-322-5320
Mailing Address - Fax:850-848-9798
Practice Address - Street 1:1234 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1710
Practice Address - Country:US
Practice Address - Phone:850-656-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNCS000279122300000X
GADN013963122300000X
FLDN20540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist