Provider Demographics
NPI:1144422270
Name:MARCIE MCKINNEY D.D.S., P.A.
Entity Type:Organization
Organization Name:MARCIE MCKINNEY D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-494-7600
Mailing Address - Street 1:807 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4003
Mailing Address - Country:US
Mailing Address - Phone:479-494-7600
Mailing Address - Fax:479-494-7603
Practice Address - Street 1:807 S 21ST ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4003
Practice Address - Country:US
Practice Address - Phone:479-494-7600
Practice Address - Fax:479-494-7603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3303251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1376637587OtherTYPE I NPI
AR=========OtherTAX ID