Provider Demographics
NPI:1699835165
Name:MCKENZIE, RODERICK K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:K
Last Name:MCKENZIE
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 1:5121 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8580
Mailing Address - Country:US
Mailing Address - Phone:423-238-5751
Mailing Address - Fax:423-238-6388
Practice Address - Street 1:5121 OOLTEWAH RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-8580
Practice Address - Country:US
Practice Address - Phone:423-238-5751
Practice Address - Fax:423-238-6388
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS33481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0017780OtherBLUE CROSS BLUE SHIELD