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General NPI Number Information
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NPI Number | 1740724681
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Entity Type | Organization
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Legal Business Name | TRACY E. WALTERS DDS PA DBA SMILETASTIC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 4850 SUN N LAKE BLVD
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City | SEBRING
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State | FL
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Zip | 33872-2110
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Country | US
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Telephone | 863-658-3276
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Fax | 863-658-3290
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Provider Business Mailing Address
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Address Line | 4850 SUN N LAKE BLVD
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City | SEBRING
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State | FL
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Zip | 33872-2110
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Country | US
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Telephone | 863-658-3276
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Fax | 863-658-3290
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. TRACY E. WALTERS
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Credential | DDS
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Telephone | 863-658-3276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN21053
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License Number State | FL
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