Individual
DR. TRACY L DURANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
1125 N ANDERSON RD, SUITE 104, ROCK HILL, SC 29730-2776
(803) 325-8178
(803) 325-8179
Mailing address
1125 N ANDERSON RD, SUITE 104, ROCK HILL, SC 29730-2776
(803) 325-8178
(803) 325-8179
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3506
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
710905114
EMPLOYEE I.D. NUMBER
SC
05
—
ZA9577
—
SC
Enumeration date
05/25/2007
Last updated
10/10/2012
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