Provider Demographics
NPI:1033404751
Name:MCKAY, NICOLE MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 NE CAMPUS WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5611
Mailing Address - Country:US
Mailing Address - Phone:775-720-9324
Mailing Address - Fax:
Practice Address - Street 1:4104 SE 82ND AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2954
Practice Address - Country:US
Practice Address - Phone:503-771-4324
Practice Address - Fax:503-771-4458
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist