Healthcare Provider Details

I. General information

NPI: 1619082260
Provider Name (Legal Business Name): HENRY EARL MCKAY III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 VALLEYDALE ROAD SUITE 100
BIRMINGHAM AL
35244-2011
US

IV. Provider business mailing address

2290 VALLEYDALE ROAD SUITE 100
BIRMINGHAM AL
35244-2011
US

V. Phone/Fax

Practice location:
  • Phone: 205-682-1099
  • Fax: 205-403-7383
Mailing address:
  • Phone: 205-682-1099
  • Fax: 205-403-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4649
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: