Provider Demographics
NPI:1003823832
Name:PRICE, MCKINLEY LENARD (DDS)
Entity Type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:LENARD
Last Name:PRICE
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 1:635 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1980
Mailing Address - Country:US
Mailing Address - Phone:757-873-2888
Mailing Address - Fax:757-873-2444
Practice Address - Street 1:635 PILOT HOUSE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1980
Practice Address - Country:US
Practice Address - Phone:757-873-2888
Practice Address - Fax:757-873-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010050721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
321044OtherANTHEM
VA9178617Medicaid