Provider Demographics
NPI:1134305683
Name:KENNETH R. MCGRATH, D.D.S., P.A.
Entity Type:Organization
Organization Name:KENNETH R. MCGRATH, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-896-7660
Mailing Address - Street 1:8301 MAGNOLIA ESTATES DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8050
Mailing Address - Country:US
Mailing Address - Phone:704-896-7660
Mailing Address - Fax:
Practice Address - Street 1:8301 MAGNOLIA ESTATES DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8050
Practice Address - Country:US
Practice Address - Phone:704-896-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6243261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental