Provider Demographics
NPI:1215906573
Name:DELLINGER, TRACY MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MICHELLE
Last Name:DELLINGER
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 1:212 MANDARIN DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8299
Mailing Address - Country:US
Mailing Address - Phone:601-984-6028
Mailing Address - Fax:601-984-6039
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:UNIVERSITY OF MISSISSIPPI SCHOOL OF DENTISTRY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6028
Practice Address - Fax:601-984-6039
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS 3034-98122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist