Provider Demographics
NPI:1942214200
Name:MCKONE DENTAL CARE DDS PA
Entity Type:Organization
Organization Name:MCKONE DENTAL CARE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NEHL
Authorized Official - Last Name:MCKONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-475-9170
Mailing Address - Street 1:109 BUSHAWAY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1945
Mailing Address - Country:US
Mailing Address - Phone:952-475-0225
Mailing Address - Fax:
Practice Address - Street 1:109 BUSHAWAY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1945
Practice Address - Country:US
Practice Address - Phone:952-475-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND81461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty