Organization
DENTAL DESIGN P.C.
Active
Other names
Tracy E. Mathis DDS P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY ELAINE BLOUNT DDS (PRESIDENT)
(616) 452-0400
Entity
Organization
Contact information
Practice address
2021 44TH ST SE STE B, GRAND RAPIDS, MI 49508-5349
(616) 452-0400
(855) 918-1014
Mailing address
PO BOX 88007, GRAND RAPIDS, MI 49518-0007
(616) 452-0400
(855) 918-1014
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901015828
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2759918
—
MI
Enumeration date
09/20/2006
Last updated
11/14/2019
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