Provider Demographics
NPI:1932169679
Name:MACKEY, TRACY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEE
Last Name:MACKEY
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 1:6736 E GELDING DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3495
Mailing Address - Country:US
Mailing Address - Phone:480-443-7640
Mailing Address - Fax:
Practice Address - Street 1:6226 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-6241
Practice Address - Country:US
Practice Address - Phone:602-242-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice