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General NPI Number Information
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NPI Number | 1851185904
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Entity Type | Organization
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Legal Business Name | MCKINNEY ORAL SURGERY LLC
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Dates
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Enumeration Date | 04/05/2025
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 3001 BUSHY PARK RD
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City | MONCKS CORNER
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State | SC
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Zip | 29461-6480
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Country | US
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Telephone | 706-831-4706
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 N MAIN ST # 1473
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City | SUMMERVILLE
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State | SC
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Zip | 29483-7308
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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 | ORAL SURGEON
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Name | RICHARD MCKINNEY
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Credential | DMD
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Telephone | 706-831-4706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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