Provider Demographics
NPI:1194089284
Name:CHRIS MCKINNEY DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:CHRIS MCKINNEY DDS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-485-6600
Mailing Address - Street 1:15525 POMERADO RD STE C6
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2426
Mailing Address - Country:US
Mailing Address - Phone:858-485-6600
Mailing Address - Fax:858-673-5546
Practice Address - Street 1:15525 POMERADO RD STE C6
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2426
Practice Address - Country:US
Practice Address - Phone:858-485-6600
Practice Address - Fax:858-673-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty