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General NPI Number Information
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NPI Number | 1669686507
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Entity Type | Organization
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Legal Business Name | MCKENNA ORTHODONTICS PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 619 HOPMEADOW ST
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City | SIMSBURY
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State | CT
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Zip | 06070-2449
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Country | US
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Telephone | 860-651-9391
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Fax | 960-651-7424
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Provider Business Mailing Address
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Address Line | 619 HOPMEADOW ST
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City | SIMSBURY
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State | CT
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Zip | 06070-2449
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Country | US
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Telephone | 860-651-9391
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Fax | 960-651-7424
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL JOSEPH MCKENNA JR.
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Credential | DMD
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Telephone | 860-651-9391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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