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Individual

MRS. TRACY L. CROCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RDH

Contact information

Practice address
676 OLD LEWISTON ROAD, WINTHROP, ME 04364-4119
(207) 377-7003
Mailing address
PO BOX 275, WINTHROP, ME 04364-0275
(207) 377-7003

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH2428
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
431944500
ME
Enumeration date
05/20/2009
Last updated
05/20/2009
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