=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790354926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH MCKAY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2021
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 LIOBA DR
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67002-9076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-733-2415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 428 LIOBA DR
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67002-9076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-733-2415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 61860
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------