Provider Demographics
NPI:1699710855
Name:WILLIAMS-LEGETTE, TRACIE (DDS)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:
Last Name:WILLIAMS-LEGETTE
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:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0671
Mailing Address - Country:US
Mailing Address - Phone:910-644-9927
Mailing Address - Fax:
Practice Address - Street 1:4823 ROSEHILL RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6938
Practice Address - Country:US
Practice Address - Phone:910-482-4442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-9013Medicaid