Individual
TRACEY WHITLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
1201 N STONEWALL AVE, OKLAHOMA CITY, OK 73117-1214
(405) 271-8294
Mailing address
1201 N STONEWALL AVE RM 524B, OKLAHOMA CITY, OK 73117-1214
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6641
OK
Other
Enumeration date
08/28/2014
Last updated
01/08/2020
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