Provider Demographics
NPI:1295714285
Name:NEARY, TRACEY (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:NEARY
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 1:14 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7323
Mailing Address - Country:US
Mailing Address - Phone:570-655-8006
Mailing Address - Fax:
Practice Address - Street 1:40 N MARKET ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-1411
Practice Address - Country:US
Practice Address - Phone:570-735-2315
Practice Address - Fax:570-735-9171
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028547L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist