Individual
JACINTA TRACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(914) 216-2106
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019036241
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2025
Last updated
07/09/2025
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