Provider Demographics
NPI:1235236647
Name:JEFFREY R. MCKECHNIE, DMD, PC
Entity Type:Organization
Organization Name:JEFFREY R. MCKECHNIE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKECHNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-253-7932
Mailing Address - Street 1:PO BOX 1543
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-1543
Mailing Address - Country:US
Mailing Address - Phone:802-253-7932
Mailing Address - Fax:802-253-6220
Practice Address - Street 1:CORNER OF RT. 100 AND RT. 108
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672
Practice Address - Country:US
Practice Address - Phone:802-253-7932
Practice Address - Fax:802-253-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00007471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002418Medicaid
VT1008782Medicaid