Healthcare Provider Details

I. General information

NPI: 1598872715
Provider Name (Legal Business Name): TRACY L MAYFIELD DMD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 VILLAGE PARKWAY
HELENA AL
35080
US

IV. Provider business mailing address

215 VILLAGE PARKWAY
HELENA AL
35080
US

V. Phone/Fax

Practice location:
  • Phone: 205-620-9222
  • Fax:
Mailing address:
  • Phone: 205-620-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberAL4448
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: