Provider Demographics
NPI:1376623041
Name:MCKINNON, HAL H JR (DDS)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:H
Last Name:MCKINNON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3288 ROBINHOOD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5464
Mailing Address - Country:US
Mailing Address - Phone:336-659-7700
Mailing Address - Fax:336-659-0037
Practice Address - Street 1:3288 ROBINHOOD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5464
Practice Address - Country:US
Practice Address - Phone:336-659-7700
Practice Address - Fax:336-659-0037
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC39501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3950OtherSTATE LICENSE
NC8995820Medicaid
NC3950OtherSTATE LICENSE