Provider Demographics
NPI:1144676644
Name:MCKENZIE-DEHNERT, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MCKENZIE-DEHNERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 694
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:VA
Mailing Address - Zip Code:23128
Mailing Address - Country:US
Mailing Address - Phone:804-505-1012
Mailing Address - Fax:757-299-4451
Practice Address - Street 1:8183 GENTIL CT
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-4654
Practice Address - Country:US
Practice Address - Phone:804-505-1012
Practice Address - Fax:757-299-4451
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi