Provider Demographics
NPI:1003949371
Name:MACKIN, DENNIS J (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:MACKIN
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 1:701 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981
Mailing Address - Country:US
Mailing Address - Phone:715-258-3311
Mailing Address - Fax:715-258-4104
Practice Address - Street 1:701 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981
Practice Address - Country:US
Practice Address - Phone:715-258-3311
Practice Address - Fax:715-258-4104
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice