Provider Demographics
NPI:1992719264
Name:MCCRARY, REX POWELL (DMD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:POWELL
Last Name:MCCRARY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MAIN ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2455
Mailing Address - Country:US
Mailing Address - Phone:859-744-2512
Mailing Address - Fax:859-231-8988
Practice Address - Street 1:201 S MAIN ST
Practice Address - Street 2:STE. 201
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2455
Practice Address - Country:US
Practice Address - Phone:859-744-2512
Practice Address - Fax:859-231-8988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60064615Medicaid