# DENTAL DESIGN P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tracy E. Mathis DDS P.C.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891892006
- **Authorized official:** DR. TRACY ELAINE BLOUNT DDS (PRESIDENT)
- **Authorized official phone:** (616) 452-0400

## Contact information

- **Practice address:** 2021 44TH ST SE STE B, GRAND RAPIDS, MI 49508-5349
- **Practice address phone:** (616) 452-0400
- **Practice address fax:** (855) 918-1014
- **Mailing address:** PO BOX 88007, GRAND RAPIDS, MI 49518-0007
- **Mailing address phone:** (616) 452-0400
- **Mailing address fax:** (855) 918-1014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901015828 | MI | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 11/14/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2759918 | — | MI |