Provider Demographics
NPI:1003434747
Name:MCKINNEY FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:MCKINNEY FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-791-4153
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:MINNIE
Mailing Address - State:KY
Mailing Address - Zip Code:41651-0060
Mailing Address - Country:US
Mailing Address - Phone:606-377-0170
Mailing Address - Fax:606-377-0179
Practice Address - Street 1:JCT ROUTE 680 & HWY 122
Practice Address - Street 2:
Practice Address - City:MINNIE
Practice Address - State:KY
Practice Address - Zip Code:41651
Practice Address - Country:US
Practice Address - Phone:606-377-0170
Practice Address - Fax:606-377-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1295874147OtherNPI NUMBER
KY8085OtherSTATE LICENSE NUMBER