MEDICARE: DR. TRACY LEE MACKEY 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	1223G0001X	General Practice Dentistry	5417	AZ

General Provider Information

NPI Number	:	1932169679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY LEE MACKEY DDS

Provider Business Mailing Address
First Line	:	6736 E GELDING DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-3495
Country	:	US
Telephone Number	:	480-443-7640
Fax Number	:

Provider Business Practice Location Address
First Line	:	6226 N 27TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-6241
Country	:	US
Telephone Number	:	602-242-3368
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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