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General NPI Number Information
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NPI Number | 1164697405
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Entity Type | Organization
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Legal Business Name | DR. TRACY L. DURANT, INC.
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 1125 ANDERSON RD N SUTIE 104
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City | ROCK HILL
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State | SC
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Zip | 29730-2776
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Country | US
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Telephone | 803-325-8178
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 ANDERSON RD N SUTIE 104
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City | ROCK HILL
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State | SC
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Zip | 29730-2776
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Country | US
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Telephone | 803-325-8178
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. TRACY LYNDELL DURANT
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Credential | DDS
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Telephone | 80933258178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3506
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License Number State | SC
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