Provider Demographics
NPI:1912031279
Name:KRIEGER, TRACY ROCHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ROCHELLE
Last Name:KRIEGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:ROCHELLE
Other - Last Name:GINSBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:65 MOUNTAIN BLVD EXT STE 101
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2633
Mailing Address - Country:US
Mailing Address - Phone:732-356-9494
Mailing Address - Fax:732-356-0124
Practice Address - Street 1:65 MOUNTAIN BLVD EXT STE 101
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2633
Practice Address - Country:US
Practice Address - Phone:732-356-9494
Practice Address - Fax:732-356-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics