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Organization
JOHNNY L. MCKINNON, JR., D.D.S., P.A.
Active
Organization
JOHNNY L. MCKINNON, JR., D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY L. MCKINNON JR. D.D.S. (PRESIDENT/DENTIST)
(910) 439-9744
Entity
Organization
Contact information
Practice address
407 NORTH MAIN STREET, MT. GILEAD, NC 27306-0022
(910) 439-9744
(910) 439-4113
Mailing address
PO BOX 22, 407 NORTH MAIN STREET, MOUNT GILEAD, NC 27306-0022
(910) 439-9744
(910) 439-4113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6063
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8995803
—
NC
Enumeration date
02/27/2008
Last updated
02/27/2008
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