Provider Demographics
NPI:1639207293
Name:MACARAEG, MARIA TERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TERESA
Last Name:MACARAEG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:MACARAEG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11125 MCCORMICK ROAD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9100
Mailing Address - Country:US
Mailing Address - Phone:901-351-6205
Mailing Address - Fax:
Practice Address - Street 1:ASPEN DENTAL
Practice Address - Street 2:2849 N GERMANTOWN PARKWAY
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-248-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225881Medicaid