Individual
DR. TRACEY LAMAR DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
204 WATERFORD SQ, MADISON, MS 39110-6856
(601) 856-3182
(601) 856-9120
Mailing address
204 WATERFORD SQ, MADISON, MS 39110-6856
(601) 856-3182
(601) 856-9120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3035-98
MS
Other
Enumeration date
01/02/2007
Last updated
12/03/2009
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