Provider Demographics
NPI:1104224906
Name:MACRAE, ENIKO K (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ENIKO
Middle Name:K
Last Name:MACRAE
Suffix:
Gender:F
Credentials:DMD, MS
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Mailing Address - Street 1:1090 NORTHCHASE PKWY SE STE 290
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6402
Mailing Address - Country:US
Mailing Address - Phone:770-916-9000
Mailing Address - Fax:
Practice Address - Street 1:3 K MART PLZ
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4442
Practice Address - Country:US
Practice Address - Phone:864-236-4770
Practice Address - Fax:864-552-9952
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8482 GD1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics