Provider Demographics
NPI:1366098626
Name:SALLAWAY, MCKAY LAUREN (DDS)
Entity type:Individual
Prefix:DR
First Name:MCKAY
Middle Name:LAUREN
Last Name:SALLAWAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 AMISTAD DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8391
Mailing Address - Country:US
Mailing Address - Phone:972-632-6289
Mailing Address - Fax:
Practice Address - Street 1:8501 BENBROOK BLVD # 2559
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2153
Practice Address - Country:US
Practice Address - Phone:817-529-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35492122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist