MEDICARE: DR. TRACIE PRAYLO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN014711	GA

General Provider Information

NPI Number	:	1427463926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACIE PRAYLO DDS

Provider Business Mailing Address
First Line	:	1099 MARTIN LUTHER KING JR DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2943
Country	:	US
Telephone Number	:	404-753-9742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 MARTIN LUTHER KING JR DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2943
Country	:	US
Telephone Number	:	404-753-9742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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