Provider Demographics
NPI:1780011155
Name:MCRAE, KESHA LENITA (DDS)
Entity type:Individual
Prefix:DR
First Name:KESHA
Middle Name:LENITA
Last Name:MCRAE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 BROAD ST SE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3726
Mailing Address - Country:US
Mailing Address - Phone:770-535-0445
Mailing Address - Fax:
Practice Address - Street 1:5193 PEACHTREE BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2847
Practice Address - Country:US
Practice Address - Phone:470-541-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014666122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist