1124240411 NPI number — MRS. TRACY MARIE GUILFORD D.D.S.

Table of content: MRS. TRACY MARIE GUILFORD D.D.S. (NPI 1124240411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124240411 NPI number — MRS. TRACY MARIE GUILFORD D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUILFORD
Provider First Name:
TRACY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALSH
Provider Other First Name:
TRACY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124240411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5104 CHARLESTOWN RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-941-1400
Provider Business Mailing Address Fax Number:
812-941-8089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5104 CHARLESTOWN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-941-1400
Provider Business Practice Location Address Fax Number:
812-941-8089
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12011238A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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