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General NPI Number Information
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NPI Number | 1366098626
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Entity Type | Individual
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Provider Name | MCKAY LAUREN SALLAWAY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 8501 BENBROOK BLVD # 2559
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City | BENBROOK
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State | TX
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Zip | 76126-2153
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Country | US
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Telephone | 817-529-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 AMISTAD DR
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City | PROSPER
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State | TX
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Zip | 75078-8391
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Country | US
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Telephone | 972-632-6289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35492
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 35492
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License Number State | TX
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