Provider Demographics
NPI:1184941353
Name:MCRAE, DEXTER DION (DDS)
Entity type:Individual
Prefix:DR
First Name:DEXTER
Middle Name:DION
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 1:10274 LAKE ARBOR WAY
Mailing Address - Street 2:SUITE#203
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3146
Mailing Address - Country:US
Mailing Address - Phone:301-808-3909
Mailing Address - Fax:301-808-3908
Practice Address - Street 1:10274 LAKE ARBOR WAY
Practice Address - Street 2:SUITE#203
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-3146
Practice Address - Country:US
Practice Address - Phone:301-808-3909
Practice Address - Fax:301-808-3908
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist