Provider Demographics
NPI:1356562599
Name:MCKENZIE, WILLIAM THOMAS JR (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:MCKENZIE
Suffix:JR
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 TAMIAMI TRL
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8159
Mailing Address - Country:US
Mailing Address - Phone:941-629-3443
Mailing Address - Fax:941-629-7616
Practice Address - Street 1:3443 TAMIAMI TRL
Practice Address - Street 2:SUITE D
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8159
Practice Address - Country:US
Practice Address - Phone:941-629-3443
Practice Address - Fax:941-629-7616
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN114861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics