Provider Demographics
NPI:1598352403
Name:VRBA, MCKENZIE ALAYNE (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ALAYNE
Last Name:VRBA
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:ALAYNE
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:CERESCO
Mailing Address - State:NE
Mailing Address - Zip Code:68017-4131
Mailing Address - Country:US
Mailing Address - Phone:140-291-0347
Mailing Address - Fax:
Practice Address - Street 1:209 LAURA LN
Practice Address - Street 2:
Practice Address - City:CERESCO
Practice Address - State:NE
Practice Address - Zip Code:68017-4131
Practice Address - Country:US
Practice Address - Phone:140-291-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant