Provider Demographics
NPI:1326892373
Name:MCCRAY, AUDREY NICOLE (RDH,MBA)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:NICOLE
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:RDH,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28160 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-4289
Mailing Address - Country:US
Mailing Address - Phone:301-884-3248
Mailing Address - Fax:866-219-6469
Practice Address - Street 1:28160 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-4289
Practice Address - Country:US
Practice Address - Phone:301-884-3248
Practice Address - Fax:866-219-6469
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6877124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist