| NPI | 1891892006 |
|---|---|
| Former Legal Business Name | TRACY E. MATHIS DDS P.C. |
| Entity Type | Organization |
| Authorized Contact | TRACY ELAINE BLOUNT President 616-452-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901015828) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-11-14 |