Individual
MICHAEL WILLIAM MACKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13592 RIVER RD, SUITE #1, DESTREHAN, LA 70047-5073
(985) 764-2351
(985) 764-7510
Mailing address
13592 RIVER RD, SUITE #1, DESTREHAN, LA 70047-5073
(985) 764-2351
(985) 764-7510
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3088
LA
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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