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Organization
TRACY NICOLE DDS A PROFESSIONAL DENTAL CORPORATION
Active
Organization
TRACY NICOLE DDS A PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY NICOLE DDS (OWNER PRESIDENT OF CORP)
(949) 497-3397
Entity
Organization
Contact information
Practice address
330 PARK AVE, SUITE 1, LAGUNA BEACH, CA 92657
(949) 497-3397
(949) 497-0227
Mailing address
330 PARK AVE, SUITE 1, LAGUNA BEACH, CA 92657
(949) 497-3397
(949) 497-0227
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
45231
CA
Other
Enumeration date
08/18/2006
Last updated
08/22/2020
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