Provider Demographics
NPI:1922568666
Name:MCKENZIE ORAL AND FACIAL SURGERY PLLC
Entity Type:Organization
Organization Name:MCKENZIE ORAL AND FACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:615-441-1441
Mailing Address - Street 1:445 HENSLEE DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2166
Mailing Address - Country:US
Mailing Address - Phone:615-441-1441
Mailing Address - Fax:615-441-1460
Practice Address - Street 1:445 HENSLEE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2166
Practice Address - Country:US
Practice Address - Phone:615-441-1441
Practice Address - Fax:615-441-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty