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General NPI Number Information
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NPI Number | 1811349772
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Entity Type | Individual
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Provider Name | ANDREW JAMES MCKENNA DDS
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Gender | Male
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 3817 GRUBER RD
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City | FORT BRAGG
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State | NC
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Zip | 28310-8925
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Country | US
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Telephone | 910-396-1572
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Fax |
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Provider Business Mailing Address
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Address Line | 1434 PORTER ST
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City | FREDERICK
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State | MD
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Zip | 21702
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS040867
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License Number State | PA
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