Provider Demographics
NPI:1740372481
Name:MCRAITH, MICHAEL J (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MCRAITH
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 1:6400 WESTPARK DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-7399
Mailing Address - Country:US
Mailing Address - Phone:713-977-6917
Mailing Address - Fax:713-534-1354
Practice Address - Street 1:6400 WESTPARK DR
Practice Address - Street 2:SUITE 325
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-7399
Practice Address - Country:US
Practice Address - Phone:713-977-6917
Practice Address - Fax:713-534-1354
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist