Provider Demographics
NPI:1972642734
Name:MCKINNEY, MICHAEL KENT JR (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENT
Last Name:MCKINNEY
Suffix:JR
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:JCT RT. 680 & HWY 122
Mailing Address - Street 2:
Mailing Address - City:MINNIE
Mailing Address - State:KY
Mailing Address - Zip Code:41651
Mailing Address - Country:US
Mailing Address - Phone:606-377-0170
Mailing Address - Fax:606-377-0179
Practice Address - Street 1:JCT RT. 680 & HWY 122
Practice Address - Street 2:
Practice Address - City:MINNIE
Practice Address - State:KY
Practice Address - Zip Code:41651
Practice Address - Country:US
Practice Address - Phone:606-377-0170
Practice Address - Fax:606-377-0179
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY68731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61900163Medicaid
KY60068731Medicaid