Organization
TRACIE L. VESTAL, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACIE LEIGH VESTAL DDS (OWNER)
(910) 371-5965
Entity
Organization
Contact information
Practice address
1014B GRANDIFLORA DR, LELAND, NC 28451-7454
(910) 371-5965
Mailing address
1014B GRANDIFLORA DR, LELAND, NC 28451-7454
(910) 371-5965
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7200
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7200
DENTAL LICENSE #
NC
05
—
89902EC
—
NC
01
—
902EC
BCBS #
NC
Enumeration date
04/17/2008
Last updated
03/07/2023
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