Provider Demographics
NPI:1801223334
Name:CHARGING CROW, TRACY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:CHARGING CROW
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 1:4022 RAYNOR PKWY APT 224
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-6131
Mailing Address - Country:US
Mailing Address - Phone:402-885-3788
Mailing Address - Fax:
Practice Address - Street 1:2602 J ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1643
Practice Address - Country:US
Practice Address - Phone:402-733-1325
Practice Address - Fax:402-733-1325
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist