Provider Demographics
NPI:1124103494
Name:EDWARDS, TRACY MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 S CHURCH ST
Mailing Address - Street 2:CORRECT TIME PLAZA
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9150
Mailing Address - Country:US
Mailing Address - Phone:336-584-7728
Mailing Address - Fax:336-584-8730
Practice Address - Street 1:3320 S CHURCH ST
Practice Address - Street 2:CORRECT TIME PLAZA
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9150
Practice Address - Country:US
Practice Address - Phone:336-584-7728
Practice Address - Fax:336-584-8730
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice