Provider Demographics
NPI:1780200279
Name:VRACAR, TAYLOR RAE (DMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:VRACAR
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 1:1387 RIVER LOOK CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-7919
Mailing Address - Country:US
Mailing Address - Phone:386-457-0566
Mailing Address - Fax:
Practice Address - Street 1:875 UNION AVE STE 301
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3513
Practice Address - Country:US
Practice Address - Phone:901-448-6213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234141223G0001X
TN113081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice