Provider Demographics
NPI:1457572562
Name:MCKINNEY, COLIN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:MICHAEL
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 SW WILDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2168
Mailing Address - Country:US
Mailing Address - Phone:772-692-6996
Mailing Address - Fax:772-692-7787
Practice Address - Street 1:800 SE OSCEOLA ST
Practice Address - Street 2:SUITE A
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2447
Practice Address - Country:US
Practice Address - Phone:772-283-6313
Practice Address - Fax:772-287-9515
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice