Provider Demographics
NPI:1629103148
Name:TRACY M. CREAR, D.D.S. & ASSOCIATES
Entity Type:Organization
Organization Name:TRACY M. CREAR, D.D.S. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CREAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-774-3934
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:225-774-3934
Mailing Address - Fax:225-774-3980
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:225-774-3934
Practice Address - Fax:225-774-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1880728Medicaid