Provider Demographics
NPI:1427107390
Name:VEST, TRACEY M (DMD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:VEST
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 1:153 MANCHESTER ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-224-9474
Mailing Address - Fax:603-224-9232
Practice Address - Street 1:153 MANCHESTER ST
Practice Address - Street 2:SUITE #5
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-224-9474
Practice Address - Fax:603-224-9232
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH32901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHBV4747133OtherDEA PHARMACY