Provider Demographics
NPI:1699984526
Name:PACKER, MCKAY B (DDS)
Entity type:Individual
Prefix:DR
First Name:MCKAY
Middle Name:B
Last Name:PACKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 FORT UNION BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1885
Mailing Address - Country:US
Mailing Address - Phone:801-566-5959
Mailing Address - Fax:801-304-9322
Practice Address - Street 1:1275 FORT UNION BLVD STE 210
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1885
Practice Address - Country:US
Practice Address - Phone:801-566-5959
Practice Address - Fax:801-304-9322
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6221162-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice