Healthcare Provider Details

I. General information

NPI: 1871402263
Provider Name (Legal Business Name): MCKENNA ORTIZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENNA HUNTER DDS

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 GREENVIEW DR
EL DORADO HILLS CA
95762-5215
US

IV. Provider business mailing address

3625 GREENVIEW DR
EL DORADO HILLS CA
95762-5215
US

V. Phone/Fax

Practice location:
  • Phone: 916-221-2511
  • Fax:
Mailing address:
  • Phone: 916-221-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: