Organization
PHILLIP M. MCKEAN PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKEY RAY HULLINGER (OFFICE MANAGER)
(260) 486-2339
Entity
Organization
Contact information
Practice address
6605 E STATE BLVD STE 7, FORT WAYNE, IN 46815-7036
(260) 486-2339
(260) 486-3219
Mailing address
6605 E STATE BLVD STE 7, FORT WAYNE, IN 46815-7036
(260) 486-2339
(260) 486-3219
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028091
—
IN
Enumeration date
09/06/2019
Last updated
09/06/2019
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