Provider Demographics
NPI:1770704702
Name:EPLEY, TRACEY BETH (DMD)
Entity type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:BETH
Last Name:EPLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 VICTORIAN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3161
Mailing Address - Country:US
Mailing Address - Phone:248-207-7544
Mailing Address - Fax:
Practice Address - Street 1:919 CHESTER RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4844
Practice Address - Country:US
Practice Address - Phone:517-487-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010192721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice