Provider Demographics
NPI:1083230866
Name:LECROY, MACKENZIE SEWELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:SEWELL
Last Name:LECROY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 13TH AVENUE PL NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2549
Mailing Address - Country:US
Mailing Address - Phone:828-328-5581
Mailing Address - Fax:
Practice Address - Street 1:221 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2549
Practice Address - Country:US
Practice Address - Phone:828-328-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice