Provider Demographics
NPI:1730116948
Name:MCKINLEY, MARK PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PATRICK
Last Name:MCKINLEY
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 1:606 SEABROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2914
Mailing Address - Country:US
Mailing Address - Phone:410-832-0178
Mailing Address - Fax:410-391-3195
Practice Address - Street 1:707 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:410-391-5050
Practice Address - Fax:410-391-3195
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD083511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice