# PHILLIP M. MCKEAN PROFESSIONAL CORPORATION

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

## Provider details

- **NPI number:** 1699324103
- **Authorized official:** VICKEY RAY HULLINGER (OFFICE MANAGER)
- **Authorized official phone:** (260) 486-2339

## Contact information

- **Practice address:** 6605 E STATE BLVD STE 7, FORT WAYNE, IN 46815-7036
- **Practice address phone:** (260) 486-2339
- **Practice address fax:** (260) 486-3219
- **Mailing address:** 6605 E STATE BLVD STE 7, FORT WAYNE, IN 46815-7036
- **Mailing address phone:** (260) 486-2339
- **Mailing address fax:** (260) 486-3219

## Taxonomy

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

## Other

- **Enumeration date:** 09/06/2019
- **Last updated:** 09/06/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 300028091 | — | IN |