Provider Demographics
NPI:1740997071
Name:MACKAY DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:MACKAY DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-296-0296
Mailing Address - Street 1:134 RED MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-0886
Mailing Address - Country:US
Mailing Address - Phone:706-296-0296
Mailing Address - Fax:
Practice Address - Street 1:1725 ELECTRIC AVE STE 138
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-2607
Practice Address - Country:US
Practice Address - Phone:706-296-0296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty