Provider Demographics
NPI:1285755215
Name:MCRAE, ALEXANDER B (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:B
Last Name:MCRAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 W DUVAL RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4344
Mailing Address - Country:US
Mailing Address - Phone:520-625-0131
Mailing Address - Fax:520-625-6998
Practice Address - Street 1:267 W DUVAL RD
Practice Address - Street 2:STE. 105
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4344
Practice Address - Country:US
Practice Address - Phone:520-625-0131
Practice Address - Fax:520-625-6998
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ15621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ1562OtherDENTAL LICENSE
AZ2560717OtherDEA FEDERAL