Healthcare Provider Details

I. General information

NPI: 1821828351
Provider Name (Legal Business Name): ABRAHAM MCKAY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ADAMS AVE PKWY STE 9
OGDEN UT
84405-6955
US

IV. Provider business mailing address

7236 S 1250 E
SOUTH WEBER UT
84405-8400
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-9448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM MCKAY
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 801-935-0155