Healthcare Provider Details

I. General information

NPI: 1619384047
Provider Name (Legal Business Name): TRACEY RENAE COBB DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8327 E 12 MILE RD
WARREN MI
48093-2769
US

IV. Provider business mailing address

8327 E 12 MILE RD
WARREN MI
48093-2769
US

V. Phone/Fax

Practice location:
  • Phone: 586-693-0202
  • Fax: 586-693-0378
Mailing address:
  • Phone: 586-693-0202
  • Fax: 586-693-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021365
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: