Individual
TRACY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1211 DAISY CT, HOLLY RIDGE, NC 28445-7989
(318) 278-7824
Mailing address
2017 GREYSTEM CIR, APT.206, GURNEE, IL 60031-9352
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN1001700
DC
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
Other
Enumeration date
03/09/2017
Last updated
11/27/2017
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