Provider Demographics
NPI:1194767103
Name:MCKENZIE, MARIA ANTONIA (RDH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANTONIA
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 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD,
Mailing Address - State:CO
Mailing Address - Zip Code:80115-3611
Mailing Address - Country:US
Mailing Address - Phone:303-361-1977
Mailing Address - Fax:303-761-2787
Practice Address - Street 1:15132 E HAMPDEN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5072
Practice Address - Country:US
Practice Address - Phone:303-762-6546
Practice Address - Fax:303-762-6550
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000904142124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist