Provider Demographics
NPI:1750300117
Name:MCKENZIE, JAMES SPAIN (DDS PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SPAIN
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BRAMBLEHILL DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2377
Mailing Address - Country:US
Mailing Address - Phone:919-552-1044
Mailing Address - Fax:919-552-3790
Practice Address - Street 1:212 BRAMBLEHILL DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2377
Practice Address - Country:US
Practice Address - Phone:919-552-1044
Practice Address - Fax:919-552-3790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist