Individual
JOHNNY L. MCKINNON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
407 N MAIN ST, MOUNT GILEAD, NC 27306-0407
(910) 439-9744
(910) 439-4113
Mailing address
PO BOX 22, 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
09/26/2006
Last updated
07/09/2007
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