Healthcare Provider Details

I. General information

NPI: 1235236647
Provider Name (Legal Business Name): JEFFREY R. MCKECHNIE, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF RT. 100 AND RT. 108
STOWE VT
05672
US

IV. Provider business mailing address

PO BOX 1543
STOWE VT
05672-1543
US

V. Phone/Fax

Practice location:
  • Phone: 802-253-7932
  • Fax: 802-253-6220
Mailing address:
  • Phone: 802-253-7932
  • Fax: 802-253-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016-0000747
License Number StateVT

VIII. Authorized Official

Name: DR. JEFFREY R MCKECHNIE
Title or Position: PRESIDENT
Credential: DMD
Phone: 802-253-7932