MEDICARE: DR. DEXTER DION MCRAE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12620	MD

General Provider Information

NPI Number	:	1184941353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEXTER DION MCRAE DDS

Provider Business Mailing Address
First Line	:	10274 LAKE ARBOR WAY
Second Line	:	SUITE#203
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-3146
Country	:	US
Telephone Number	:	301-808-3909
Fax Number	:	301-808-3908

Provider Business Practice Location Address
First Line	:	10274 LAKE ARBOR WAY
Second Line	:	SUITE#203
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-3146
Country	:	US
Telephone Number	:	301-808-3909
Fax Number	:	301-808-3908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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