Provider Demographics
NPI:1336700228
Name:SWAN, MCKENZIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 SOUTHWEST TRFY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2710
Mailing Address - Country:US
Mailing Address - Phone:417-209-0619
Mailing Address - Fax:
Practice Address - Street 1:21620 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66218-9064
Practice Address - Country:US
Practice Address - Phone:913-439-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS616561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice