Provider Demographics
NPI:1982309688
Name:MCKENZIE, DANIEL JAMES (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
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 1:4900 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2131
Mailing Address - Country:US
Mailing Address - Phone:309-642-7812
Mailing Address - Fax:
Practice Address - Street 1:40 W CALDWELL ST
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2910
Practice Address - Country:US
Practice Address - Phone:615-754-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN124781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice