Provider Demographics
NPI:1942259254
Name:CHRISTION, TRACEY DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:DENISE
Last Name:CHRISTION
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 1:1331 UNION AVE STE 1225
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7551
Mailing Address - Country:US
Mailing Address - Phone:901-276-7314
Mailing Address - Fax:901-276-6028
Practice Address - Street 1:6757 E SHELBY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-7846
Practice Address - Country:US
Practice Address - Phone:901-363-3144
Practice Address - Fax:901-363-3143
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1942259254Medicaid