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Organization
MCKISSOCK CORP
Active
Organization
MCKISSOCK CORP
Active
Parent organization
MCKISSOCK CORP
Other names
Windermere Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCKISSOCK CORP
Authorized official
DR. MATTHEW DEAN MCKISSOCK D.M.D. (OWNER/PRESIDENT)
(407) 909-1099
Entity
Organization
Contact information
Practice address
4769 THE GROVE DR., SUITE 100, WINDERMERE, FL 34786
(407) 909-1099
Mailing address
4769 THE GROVE DR., SUITE 100, WINDERMERE, FL 34786
(407) 909-1099
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN16810
FL
Other
Enumeration date
05/29/2012
Last updated
05/29/2012
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