Provider Demographics
NPI:1316100241
Name:MCKINNEY, JOHN BRADLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADLEY
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 6TH ST S STE 101
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-1842
Mailing Address - Country:US
Mailing Address - Phone:205-625-3866
Mailing Address - Fax:205-274-0384
Practice Address - Street 1:308 6TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1842
Practice Address - Country:US
Practice Address - Phone:205-625-3866
Practice Address - Fax:205-274-0384
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5617122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist