Provider Demographics
NPI:1770710147
Name:MCKENZIE, KRISTA JUSTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:JUSTINE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 BAYCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-1565
Mailing Address - Country:US
Mailing Address - Phone:718-671-2826
Mailing Address - Fax:718-671-2826
Practice Address - Street 1:3370 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1565
Practice Address - Country:US
Practice Address - Phone:718-671-2826
Practice Address - Fax:718-671-2826
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0551241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice