Organization
BRAD A. MCKENZIE
Active
Other names
McKenzie Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD MCKENZIE D.D.S. (DENTIST)
(503) 622-3085
Entity
Organization
Contact information
Practice address
24540 E WELCHES RD, WELCHES, OR 97067
(503) 622-3085
(503) 622-3753
Mailing address
PO BOX 293, WELCHES, OR 97067-0293
(503) 622-3085
(503) 622-3753
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7819
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285634097
INDIVIDUAL NPI
OR
Enumeration date
03/11/2010
Last updated
03/11/2010
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