MCRAE DENTAL PA NPI 1184884348

NPI Information

NPI: 1184884348
Provider Name: MCRAE DENTAL PA
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
1067 S. WELLS ST.
MERIDIAN, ID
ZIP 83642
Phone: (208) 895-8486
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MCRAE DENTAL PA is a dental clinic center in Meridian, ID. MCRAE DENTAL PA NPI is 1184884348. The provider is registered as an organization entity type.

The provider's business location address is:

1067 S. WELLS ST.
MERIDIAN, ID
ZIP 83642-561
Phone: (208) 895-8486
Fax: (208) 895-8540

The provider's authorized official is Lon Chad Mcrae .
The authorized official title is Dr and has the following contact phone number (208) 894-8486.

The enumeration date for this NPI number is 6/11/2008 and was last updated on 10/20/2017.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	000673526W	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	805008600	MEDICAID	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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