TRACY L DAVIDIAN DDS PA NPI 1053779538

NPI Information

TRACY L DAVIDIAN DDS PA is a customized equipment durable medical equipment medical supplies in Raleigh, NC. TRACY L DAVIDIAN DDS PA NPI is 1053779538. The provider is registered as an organization entity type.
The provider Is Doing Business As Physiologic Aesthetics.

The provider's business location address is:

5904 SIX FORKS RD
SUITE 225
RALEIGH, NC
ZIP 27609-838
Phone: (919) 782-9955

The provider's authorized official is Tracy L Davidian .
The authorized official title is Dentist/owner and has the following contact phone number (919) 782-9955.

The enumeration date for this NPI number is 1/29/2016 and was last updated on 1/29/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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