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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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