Healthcare Provider Details

I. General information

NPI: 1104569862
Provider Name (Legal Business Name): CAITLIN RAE HARRAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 55TH ST
BROOKLYN NY
11220-2508
US

IV. Provider business mailing address

1342 WINDSOR POINT RD
NORFOLK VA
23509-1312
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6875
  • Fax:
Mailing address:
  • Phone: 757-831-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number109285
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401417957
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number063847
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: