# JOHNNY L. MCKINNON, JR., D.D.S., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376712075
- **Authorized official:** DR. JOHNNY L. MCKINNON JR. D.D.S. (PRESIDENT/DENTIST)
- **Authorized official phone:** (910) 439-9744

## Contact information

- **Practice address:** 407 NORTH MAIN STREET, MT. GILEAD, NC 27306-0022
- **Practice address phone:** (910) 439-9744
- **Practice address fax:** (910) 439-4113
- **Mailing address:** PO BOX 22, 407 NORTH MAIN STREET, MOUNT GILEAD, NC 27306-0022
- **Mailing address phone:** (910) 439-9744
- **Mailing address fax:** (910) 439-4113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6063 | NC | Yes |

## Other

- **Enumeration date:** 02/27/2008
- **Last updated:** 02/27/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8995803 | — | NC |