Provider Demographics
NPI:1932427317
Name:MCKENZIE, WILLIAM STUART (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STUART
Last Name:MCKENZIE
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 1:324 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1842
Mailing Address - Country:US
Mailing Address - Phone:615-329-4401
Mailing Address - Fax:
Practice Address - Street 1:324 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1842
Practice Address - Country:US
Practice Address - Phone:615-329-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5850 C1122300000X
TN100281223S0112X, 204E00000X
TN53940204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022069Medicaid