Provider Demographics
NPI:1427029511
Name:MCKENZIE, GREGG WALKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:WALKER
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ALPINE CIR.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223
Mailing Address - Country:US
Mailing Address - Phone:803-788-0900
Mailing Address - Fax:803-788-0637
Practice Address - Street 1:124 ALPINE CIR.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-788-0900
Practice Address - Fax:803-788-0637
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC23391223P0300X
GADN0089531223P0300X
LA31751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics