| Mcrae Dental Pa | |
|
1067 S. Wells St. Meridian ID 83642-3561 | |
| (208) 895-8486 | |
| (208) 895-8540 |
| Full Name | Mcrae Dental Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1067 S. Wells St., Meridian, Idaho |
| Authorized Official Name and Position | Lon Chad Mcrae (DR) |
| Authorized Official Contact | 2088948486 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcrae Dental Pa 1067 S Wells St Meridian ID 83642-7997 Ph: (208) 895-8486 | Mcrae Dental Pa 1067 S. Wells St. Meridian ID 83642-3561 Ph: (208) 895-8486 |
| NPI Number | 1184884348 |
|---|---|
| Provider Enumeration Date | 06/11/2008 |
| Last Update Date | 10/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184884348 | NPI | - | NPPES |
| 805008600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 000673526W (Idaho) | Primary |
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