Provider Demographics
NPI:1376637587
Name:MCKINNEY, MARCIE VANASCHE (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:VANASCHE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4003
Mailing Address - Country:US
Mailing Address - Phone:479-494-7600
Mailing Address - Fax:479-494-7603
Practice Address - Street 1:807 S 21ST ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4003
Practice Address - Country:US
Practice Address - Phone:479-494-7600
Practice Address - Fax:479-494-7603
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice