Provider Demographics
NPI:1447231253
Name:MCRAE, JOSEPH LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LAWRENCE
Last Name:MCRAE
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 1:5565 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3879
Mailing Address - Country:US
Mailing Address - Phone:901-767-0088
Mailing Address - Fax:901-767-2538
Practice Address - Street 1:5565 MURRAY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3879
Practice Address - Country:US
Practice Address - Phone:901-767-0088
Practice Address - Fax:901-767-2538
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery