Provider Demographics
NPI:1003902974
Name:MACRAE, RODERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:
Last Name:MACRAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HAVILAND DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2166
Mailing Address - Country:US
Mailing Address - Phone:845-278-6116
Mailing Address - Fax:845-278-6117
Practice Address - Street 1:83 HAVILAND DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2166
Practice Address - Country:US
Practice Address - Phone:845-278-6116
Practice Address - Fax:845-278-6117
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00492824Medicaid