Healthcare Provider Details

I. General information

NPI: 1780200279
Provider Name (Legal Business Name): TAYLOR RAE VRACAR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE STE 301
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

1387 RIVER LOOK CIR APT 102
MEMPHIS TN
38103-7919
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6213
  • Fax:
Mailing address:
  • Phone: 386-457-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23414
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11308
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: