Provider Demographics
NPI:1801068184
Name:MCKENZIE, SHEPPARD A IV (DDS)
Entity type:Individual
Prefix:DR
First Name:SHEPPARD
Middle Name:A
Last Name:MCKENZIE
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7501 FALLS OF NEUSE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-846-2480
Mailing Address - Fax:919-846-2482
Practice Address - Street 1:7200 STONEHENGE DR STE 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1620
Practice Address - Country:US
Practice Address - Phone:919-846-2480
Practice Address - Fax:919-846-2482
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics