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Organization
DENTAL DESIGN P.C.
Active
Organization
DENTAL DESIGN P.C.
Active
Other names
Tracy E. Mathis DDS P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY ELAINE BLOUNT DDS (PRESIDENT)
(616) 452-0400
Entity
Organization
Contact information
Practice address
2021 44TH ST SE STE B, GRAND RAPIDS, MI 49508-5349
(616) 452-0400
(855) 918-1014
Mailing address
PO BOX 88007, GRAND RAPIDS, MI 49518-0007
(616) 452-0400
(855) 918-1014
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901015828
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2759918
—
MI
Enumeration date
09/20/2006
Last updated
11/14/2019
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