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General NPI Number Information
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NPI Number | 1417305327
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Entity Type | Individual
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Provider Name | SAMANTHA J. MCKENNA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 15813 CW HADAN DR.
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City | BENNINGTON
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State | NE
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Zip | 68007-2017
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Country | US
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Telephone | 402-238-9922
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Fax | 402-238-2424
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Provider Business Mailing Address
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Address Line | 15813 CW HADAN DR.
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City | BENNINGTON
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State | NE
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Zip | 68007-2017
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Country | US
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Telephone | 402-238-9922
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Fax | 402-238-2424
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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 | 12012509A
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License Number State | IN
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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 | 7446
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License Number State | NE
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