Healthcare Provider Details

I. General information

NPI: 1851473029
Provider Name (Legal Business Name): TRACY L BILL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COURT ST STE 270
LEBANON NH
03766-6313
US

IV. Provider business mailing address

28 MOUNTAIN VIEW DR
ENFIELD NH
03748-3643
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-1830
  • Fax:
Mailing address:
  • Phone: 603-689-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2593
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: