# MCKENZIE DENTAL LABORATORY, INC

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

## Provider details

- **NPI number:** 1659617108
- **Authorized official:** RICHARD MARTIN MCKENZIE CDT (OWNER)
- **Authorized official phone:** (207) 941-8998

## Contact information

- **Practice address:** 1407 B BROADWAY, BANGOR, ME 04401-2496
- **Practice address phone:** (207) 941-8998
- **Practice address fax:** (207) 941-0222
- **Mailing address:** PO BOX 8056, BANGOR, ME 04402-8056
- **Mailing address phone:** (207) 941-8998
- **Mailing address fax:** (207) 941-0222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 126900000X | Dental Laboratory Technician | — | NULL | Yes |
| 126900000X | Dental Laboratory Technician | — | — | Yes |

## Other

- **Enumeration date:** 01/02/2013
- **Last updated:** 01/02/2013