Provider Demographics
NPI:1740314129
Name:GASBARRA, TRACY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:GASBARRA
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 1:2401 N HENNEY RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020
Mailing Address - Country:US
Mailing Address - Phone:405-390-2000
Mailing Address - Fax:405-390-2018
Practice Address - Street 1:2401 N HENNEY RD
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020
Practice Address - Country:US
Practice Address - Phone:405-390-2000
Practice Address - Fax:405-390-2018
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist