Provider Demographics
NPI:1225203334
Name:JEFFREY D MCKINLEY ETAL PTR
Entity Type:Organization
Organization Name:JEFFREY D MCKINLEY ETAL PTR
Other - Org Name:LODI FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-948-1655
Mailing Address - Street 1:109 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1308
Mailing Address - Country:US
Mailing Address - Phone:330-948-1655
Mailing Address - Fax:
Practice Address - Street 1:109 HARRIS ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1308
Practice Address - Country:US
Practice Address - Phone:330-948-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental