Provider Demographics
NPI:1689784787
Name:MOTTA, TRACY LEEANN (REGISTERED DENTAL HY)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LEEANN
Last Name:MOTTA
Suffix:
Gender:F
Credentials:REGISTERED DENTAL HY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 EASTBROOK TERRACE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2287
Mailing Address - Country:US
Mailing Address - Phone:860-829-2724
Mailing Address - Fax:
Practice Address - Street 1:359 FARMINGTON AVE
Practice Address - Street 2:CENTRAL CONNECTICUT DENTAL GROUP
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1322
Practice Address - Country:US
Practice Address - Phone:860-747-5761
Practice Address - Fax:860-747-6964
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006199124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist