Organization
MCRAE DENTAL PA
Active
Parent organization
MCRAE DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCRAE DENTAL
Authorized official
DR. LON CHAD MCRAE DMD (DR)
(208) 894-8486
Entity
Organization
Contact information
Practice address
1067 S. WELLS ST., MERIDIAN, ID 83642-3561
(208) 895-8486
(208) 895-8540
Mailing address
1067 S WELLS ST, MERIDIAN, ID 83642-7997
(208) 895-8486
(208) 895-8540
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
000673526W
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805008600
—
ID
Enumeration date
06/11/2008
Last updated
10/20/2017
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