Provider Demographics
NPI:1285841049
Name:MCKINNEY, JEREMY R (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:R
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TOWNCENTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1822
Mailing Address - Country:US
Mailing Address - Phone:205-345-5524
Mailing Address - Fax:205-345-5523
Practice Address - Street 1:401 TOWNCENTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1822
Practice Address - Country:US
Practice Address - Phone:205-345-5524
Practice Address - Fax:205-345-5523
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics