Provider Demographics
NPI:1457581217
Name:RAE, CHRISTOPHER H (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:H
Last Name:RAE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 ORANGE CAMP RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7768
Mailing Address - Country:US
Mailing Address - Phone:386-624-7658
Mailing Address - Fax:386-873-4625
Practice Address - Street 1:131 VICTORIA COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724
Practice Address - Country:US
Practice Address - Phone:386-624-7658
Practice Address - Fax:386-873-4625
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE