Provider Demographics
NPI:1689631160
Name:TRACY, STACY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:TRACY
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 1:1712 E GUADALUPE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3983
Mailing Address - Country:US
Mailing Address - Phone:480-829-8200
Mailing Address - Fax:480-967-5252
Practice Address - Street 1:1712 E GUADALUPE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3983
Practice Address - Country:US
Practice Address - Phone:480-829-8200
Practice Address - Fax:480-967-5252
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice