Provider Demographics
NPI:1831327949
Name:MCGILL, KENNETH JAMES JR (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JAMES
Last Name:MCGILL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:JAMES
Other - Last Name:MCGILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5218 MILAN RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7134
Mailing Address - Country:US
Mailing Address - Phone:419-625-2444
Mailing Address - Fax:
Practice Address - Street 1:5218 MILAN RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7134
Practice Address - Country:US
Practice Address - Phone:419-625-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30017608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist