Healthcare Provider Details

I. General information

NPI: 1033372701
Provider Name (Legal Business Name): MICHAEL J MCKINNEY MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 W 18TH ST
EDMOND OK
73013-3631
US

IV. Provider business mailing address

616 W 18TH ST
EDMOND OK
73013-3631
US

V. Phone/Fax

Practice location:
  • Phone: 405-340-7263
  • Fax: 405-285-4323
Mailing address:
  • Phone: 405-340-7263
  • Fax: 405-285-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6567
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: