Provider Demographics
NPI:1629189287
Name:MCKAY, DAVID LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LLOYD
Last Name:MCKAY
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 1:4800 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5511
Mailing Address - Country:US
Mailing Address - Phone:612-822-2176
Mailing Address - Fax:
Practice Address - Street 1:4800 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5511
Practice Address - Country:US
Practice Address - Phone:612-822-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND92721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7008464OtherTAX ID
MN7008464OtherTAX ID