NPIMap

Organization Active NPI

Tracie L. Vestal DDS PA

  • Dental Clinic/Center
  • Elizabethtown, NC
National Provider Identifier
1508039405
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
7200 Issued in NC
Legal business name
TRACIE L. VESTAL DDS PA
Practice address
500 W Broad St
Elizabethtown, NC 28337-9411
Phone
(910) 862-4078
NPI assigned
Apr 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tracie Leigh Vestal, DDSNPI 1346304250
Title
Owner
Phone
(910) 862-4078

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 7200 NC Primary

Addresses

Primary practice location

500 W Broad St
Elizabethtown, NC 28337-9411

Mailing address

500 W Broad St
Elizabethtown, NC 28337-9411
Phone (910) 862-4078

Other identifiers 3

IdentifierTypeStateIssuer
7200OtherNCNC LICENSE
902ECOtherNCBCBS PROVIDER #
89902ECMedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Tracie L Vestal DDS PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 W Broad St
Elizabethtown, NC 28337
Phone (910) 862-4078

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1508039405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W BROAD ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379411",
            "telephone_number": "910-862-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROAD ST",
            "city": "ELIZABETHTOWN",
            "state": "NC",
            "postal_code": "283379411",
            "telephone_number": "910-862-4078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACIE L. VESTAL DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "VESTAL",
        "authorized_official_first_name": "TRACIE",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-862-4078",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NC",
            "license": "7200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "7200",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "902EC",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902EC",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.