Provider Demographics
NPI:1992153985
Name:CARTRITE, MACEY BROOKE (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:MACEY
Middle Name:BROOKE
Last Name:CARTRITE
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 OLIVE ST APT 809
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2456
Mailing Address - Country:US
Mailing Address - Phone:806-683-6674
Mailing Address - Fax:
Practice Address - Street 1:1752 BROAD PARK CIR N STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7824
Practice Address - Country:US
Practice Address - Phone:817-225-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364131223X2210X, 1223S0112X
TXT6532208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X2210XDental ProvidersDentistOrofacial Pain
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program