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General NPI Number Information
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NPI Number | 1730449356
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Entity Type | Organization
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Legal Business Name | TRACYCO, LLC
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 9850 E 79TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4822
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Country | US
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Telephone | 317-645-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 9850 E 79TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4822
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Country | US
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Telephone | 317-645-7003
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JOSEPH B HADLEY
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Credential | DDS
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Telephone | 317-645-7003
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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 | 12010497A
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License Number State | IN
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