Provider Demographics
NPI:1124155684
Name:ESPINOSA, TRACI MICHELE (DMD)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:MICHELE
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 GALLERY PARK LN STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3714
Mailing Address - Country:US
Mailing Address - Phone:910-218-1222
Mailing Address - Fax:833-317-4281
Practice Address - Street 1:1124 GALLERY PARK LN STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3714
Practice Address - Country:US
Practice Address - Phone:910-218-1222
Practice Address - Fax:833-317-4281
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM25471223G0001X
NC91001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice