Provider Demographics
NPI:1255341905
Name:MCKAY, DUANE CLIFFORD (DDS)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:CLIFFORD
Last Name:MCKAY
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 1:9201 W SUNSET BLVD
Mailing Address - Street 2:SUITE 912
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3701
Mailing Address - Country:US
Mailing Address - Phone:310-274-6221
Mailing Address - Fax:310-275-7608
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:SUITE 912
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-274-6221
Practice Address - Fax:310-275-7608
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice