Provider Demographics
NPI:1619082260
Name:MCKAY, HENRY EARL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:EARL
Last Name:MCKAY
Suffix:III
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 1:2290 VALLEYDALE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2011
Mailing Address - Country:US
Mailing Address - Phone:205-682-1099
Mailing Address - Fax:205-403-7383
Practice Address - Street 1:2290 VALLEYDALE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2011
Practice Address - Country:US
Practice Address - Phone:205-682-1099
Practice Address - Fax:205-403-7383
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92636OtherBCBS PROVIDER NUMBER
AL92636Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ALU55845Medicare UPIN