Provider Demographics
NPI:1649474073
Name:HORTON, TRACEY MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:MARIE
Last Name:HORTON
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 1:126 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5011
Mailing Address - Country:US
Mailing Address - Phone:828-327-6791
Mailing Address - Fax:828-327-6791
Practice Address - Street 1:126 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5011
Practice Address - Country:US
Practice Address - Phone:828-327-6791
Practice Address - Fax:828-327-6791
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist