Provider Demographics
NPI:1124374863
Name:MCKENZIE, CELENI MARIE (RDH)
Entity type:Individual
Prefix:MRS
First Name:CELENI
Middle Name:MARIE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-9785
Mailing Address - Country:US
Mailing Address - Phone:251-510-7582
Mailing Address - Fax:
Practice Address - Street 1:7010 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 335
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3241
Practice Address - Country:US
Practice Address - Phone:703-813-8156
Practice Address - Fax:866-727-1214
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4421124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist