Provider Demographics
NPI:1720341373
Name:MCKINLEY, PATRICK J (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:MCKINLEY
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 1:1151 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3434
Mailing Address - Country:US
Mailing Address - Phone:614-725-5688
Mailing Address - Fax:614-725-5692
Practice Address - Street 1:1151 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3434
Practice Address - Country:US
Practice Address - Phone:614-725-5688
Practice Address - Fax:614-725-5692
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist