Provider Demographics
NPI:1871791640
Name:RANSDELL, TRACY MARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MARLENE
Last Name:RANSDELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12282 BLUEBIRD CANYON PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6055
Mailing Address - Country:US
Mailing Address - Phone:702-816-3312
Mailing Address - Fax:
Practice Address - Street 1:3350 NOVAT ST STE 145
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8722
Practice Address - Country:US
Practice Address - Phone:702-395-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7210122300000X
NV2890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist