Provider Demographics
NPI:1487828307
Name:JAMES S MCKENZIE DDS PA
Entity Type:Organization
Organization Name:JAMES S MCKENZIE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-552-1044
Mailing Address - Street 1:212 BRAMBLEHILL DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2377
Mailing Address - Country:US
Mailing Address - Phone:919-552-1044
Mailing Address - Fax:919-552-3790
Practice Address - Street 1:212 BRAMBLEHILL DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2377
Practice Address - Country:US
Practice Address - Phone:919-552-1044
Practice Address - Fax:919-552-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty