Provider Demographics
NPI:1427567171
Name:MCKINNEY, MICHAEL W (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
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 1:54 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-4802
Mailing Address - Country:US
Mailing Address - Phone:540-817-8338
Mailing Address - Fax:
Practice Address - Street 1:1557 COMMERCE RD STE 204
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-9703
Practice Address - Country:US
Practice Address - Phone:540-248-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice