Provider Demographics
NPI:1841595022
Name:STEPHEN LYNNE MCKEE DDS, PLLC
Entity Type:Organization
Organization Name:STEPHEN LYNNE MCKEE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-565-7811
Mailing Address - Street 1:284 STATE ROUTE 17C
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-9507
Mailing Address - Country:US
Mailing Address - Phone:607-565-7811
Mailing Address - Fax:607-565-7165
Practice Address - Street 1:284 STATE ROUTE 17C
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-9507
Practice Address - Country:US
Practice Address - Phone:607-565-7811
Practice Address - Fax:607-565-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY549191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03270284Medicaid
PA1025377340001Medicaid