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General NPI Number Information
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NPI Number | 1952733230
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Entity Type | Organization
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Legal Business Name | TRACEY TABOR WILLIAMS, DMD, PA
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 303 N ALABAMA ST SUITE 270
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2037
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Country | US
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Telephone | 317-637-4636
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Fax |
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Provider Business Mailing Address
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Address Line | 303 N ALABAMA ST SUITE 270
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-2037
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Country | US
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Telephone | 317-637-4636
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY TABOR WILLIAMS
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Credential | DMD
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Telephone | 317-637-4636
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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 | 12010679A
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License Number State | IN
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