Individual
TERRY MICHAEL MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
453 LAFAYETTE CTR, MANCHESTER, MO 63011-3943
(636) 394-5215
Mailing address
453 LAFAYETTE CTR, MANCHESTER, MO 63011-3943
(636) 394-5215
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12263
MO
Other
Enumeration date
08/07/2006
Last updated
07/08/2007
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