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Organization
TRACY L DAVIDIAN DDS PA
Active
Organization
TRACY L DAVIDIAN DDS PA
Active
Other names
Physiologic Aesthetics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY L DAVIDIAN DDS (DENTIST/OWNER)
(919) 782-9955
Entity
Organization
Contact information
Practice address
5904 SIX FORKS RD, SUITE 225, RALEIGH, NC 27609-3838
(919) 782-9955
Mailing address
5904 SIX FORKS RD, SUITE 225, RALEIGH, NC 27609-3838
(919) 782-9955
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
7149
NC
Other
Enumeration date
01/29/2016
Last updated
01/29/2016
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