Provider Demographics
NPI:1396940458
Name:PAGE, TRACY MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MICHELLE
Last Name:PAGE
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 1:6518 DORCHESTER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5100
Mailing Address - Country:US
Mailing Address - Phone:843-767-8555
Mailing Address - Fax:843-793-3344
Practice Address - Street 1:6518 DORCHESTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418
Practice Address - Country:US
Practice Address - Phone:843-767-8555
Practice Address - Fax:843-793-3344
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013427122300000X
SC46911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist