Provider Demographics
NPI:1265849103
Name:MCREE, ROBERT WADE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WADE
Last Name:MCREE
Suffix:JR
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 1:102 TRADEWINDS TER
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3354
Mailing Address - Country:US
Mailing Address - Phone:321-984-2988
Mailing Address - Fax:321-984-0464
Practice Address - Street 1:102 TRADEWINDS TER
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3354
Practice Address - Country:US
Practice Address - Phone:321-984-2988
Practice Address - Fax:321-984-0464
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice