Provider Demographics
NPI:1942472907
Name:TRACIE W. LEGETTE, DDS, MPH, PLLC
Entity Type:Organization
Organization Name:TRACIE W. LEGETTE, DDS, MPH, PLLC
Other - Org Name:COLLEGE LAKES FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS-LEGETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH
Authorized Official - Phone:910-482-4442
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0610
Mailing Address - Country:US
Mailing Address - Phone:910-482-4442
Mailing Address - Fax:910-482-4446
Practice Address - Street 1:4823 ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6938
Practice Address - Country:US
Practice Address - Phone:910-482-4442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty