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General NPI Number Information
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NPI Number | 1518280072
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Entity Type | Organization
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Legal Business Name | BRAD A. MCKENZIE
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 24540 E WELCHES RD
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City | WELCHES
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State | OR
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Zip | 97067
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Country | US
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Telephone | 503-622-3085
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Fax | 503-622-3753
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | WELCHES
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State | OR
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Zip | 97067-0293
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Country | US
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Telephone | 503-622-3085
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Fax | 503-622-3753
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BRAD MCKENZIE
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Credential | D.D.S.
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Telephone | 503-622-3085
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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 | D7819
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License Number State | OR
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