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General NPI Number Information
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NPI Number | 1669100871
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Entity Type | Individual
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Provider Name | MCKENZY LYN ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 3402 KENNEL GAP RD
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City | OAKWOOD
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State | VA
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Zip | 24631
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Country | US
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Telephone | 276-498-8069
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Fax |
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Provider Business Mailing Address
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Address Line | 117 HIGHWAY ST
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City | POUNDING MILL
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State | VA
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Zip | 24637-4111
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Country | US
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Telephone | 276-498-8060
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402207523
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License Number State | VA
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