Organization
JOHNNY L. MCKINNON, JR., D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY L. MCKINNON JR. D.D.S. (PRESIDENT/DENTIST)
(910) 439-9744
Entity
Organization
Contact information
Practice address
407 NORTH MAIN STREET, MT. GILEAD, NC 27306-0022
(910) 439-9744
(910) 439-4113
Mailing address
PO BOX 22, 407 NORTH MAIN STREET, 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
02/27/2008
Last updated
02/27/2008
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