| NPI | 1598996597 |
|---|---|
| Former Name | TRACY MICHELLE LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN20540) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DNCS000279) |
| 122300000X Dentist (Licence: GA DN013963) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2024-01-09 |