Provider Demographics
NPI:1235129453
Name:MCCRAY, JULIE FAHL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:FAHL
Last Name:MCCRAY
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:7171 DELMAR BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4334
Mailing Address - Country:US
Mailing Address - Phone:314-721-5551
Mailing Address - Fax:314-721-0123
Practice Address - Street 1:7171 DELMAR BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4334
Practice Address - Country:US
Practice Address - Phone:314-721-5551
Practice Address - Fax:314-721-0123
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0147471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7208Medicaid