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Individual

LON CHAD MCRAE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1067 S WELLS ST, MERIDIAN, ID 83642-7997
(208) 895-8486
(208) 895-8540
Mailing address
1067 S. WELLS ST., MERIDIAN, ID 83642
(208) 895-8486
(208) 895-8540

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3214
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
805008600
ID
Enumeration date
11/29/2006
Last updated
10/14/2015
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