Provider Demographics
NPI:1720571334
Name:MCRAE, CHRISTINA HOLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:HOLY
Last Name:MCRAE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6447
Mailing Address - Country:US
Mailing Address - Phone:601-572-1430
Mailing Address - Fax:
Practice Address - Street 1:3000 OLD CANTON RD STE 515
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4235
Practice Address - Country:US
Practice Address - Phone:601-713-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3998-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice