Healthcare Provider Details

I. General information

NPI: 1215906573
Provider Name (Legal Business Name): TRACY MICHELLE DELLINGER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST UNIVERSITY OF MISSISSIPPI SCHOOL OF DENTISTRY
JACKSON MS
39216-4500
US

IV. Provider business mailing address

212 MANDARIN DR
BRANDON MS
39047-8299
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6028
  • Fax: 601-984-6039
Mailing address:
  • Phone: 601-984-6028
  • Fax: 601-984-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberMS 3034-98
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: