MEDICARE: DR. TRACY MARLENE RANSDELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7210	AZ
2	122300000X	Dentist	2890	NV

General Provider Information

NPI Number	:	1871791640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY MARLENE RANSDELL DDS

Provider Business Mailing Address
First Line	:	12282 BLUEBIRD CANYON PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6055
Country	:	US
Telephone Number	:	702-816-3312
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 NOVAT ST STE 145
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8722
Country	:	US
Telephone Number	:	702-395-1088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/20/2015

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