Provider Demographics
NPI:1265719389
Name:MCKENZIE, KADIA KERRY-ANN (RDH)
Entity type:Individual
Prefix:
First Name:KADIA
Middle Name:KERRY-ANN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 38450
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8450
Mailing Address - Country:US
Mailing Address - Phone:315-645-2390
Mailing Address - Fax:
Practice Address - Street 1:UNIT 38450
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8450
Practice Address - Country:US
Practice Address - Phone:315-645-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8992124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist