Provider Demographics
NPI:1972513943
Name:MCKINNEY, SEWELL RAYBURN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEWELL
Middle Name:RAYBURN
Last Name:MCKINNEY
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 1:843 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5704
Mailing Address - Country:US
Mailing Address - Phone:901-683-4546
Mailing Address - Fax:
Practice Address - Street 1:843 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5704
Practice Address - Country:US
Practice Address - Phone:901-683-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS9641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice