| Organization Name: | TRACIE L. VESTAL, DDS, PA |
| NPI Number: | 1356515639 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACIE LEIGH VESTAL (OWNER) |
| Mailing Address: | 1014b Grandiflora Dr Leland |
| State: | NC US |
| Postal Code: | 284517454 |
| Phone Number: | 9103715965 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2008 |
| NPI Last Update Date: | 04/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 7200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |