Provider Demographics
NPI:1669686507
Name:MCKENNA ORTHODONTICS PC
Entity Type:Organization
Organization Name:MCKENNA ORTHODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-651-9391
Mailing Address - Street 1:619 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2449
Mailing Address - Country:US
Mailing Address - Phone:860-651-9391
Mailing Address - Fax:960-651-7424
Practice Address - Street 1:619 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2449
Practice Address - Country:US
Practice Address - Phone:860-651-9391
Practice Address - Fax:960-651-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty