Provider Demographics
NPI:1124254230
Name:MCKIM, JOHN PALMER (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PALMER
Last Name:MCKIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:PALMER
Other - Last Name:MCKIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1045 WILLAGILLESPIE RD SUITE 125
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-485-8717
Mailing Address - Fax:541-485-2082
Practice Address - Street 1:1045 WILLAGILLESPIE RD SUITE 125
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-485-8717
Practice Address - Fax:541-485-2082
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist