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Organization
TRACIE L. VESTAL DDS PA
Active
Organization
TRACIE L. VESTAL DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACIE LEIGH VESTAL DDS (OWNER)
(910) 862-4078
Entity
Organization
Contact information
Practice address
500 W BROAD ST, ELIZABETHTOWN, NC 28337-9411
(910) 862-4078
Mailing address
500 W BROAD ST, ELIZABETHTOWN, NC 28337-9411
(910) 862-4078
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7200
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7200
NC LICENSE
NC
05
—
89902EC
—
NC
01
—
902EC
BCBS PROVIDER #
NC
Enumeration date
04/11/2008
Last updated
03/07/2023
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