MEDICARE: DR. WILLIAM THOMAS MCKENZIE JR. DMD, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	DN11486	FL

General Provider Information

NPI Number	:	1356562599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM THOMAS MCKENZIE JR. DMD, MS

Provider Business Mailing Address
First Line	:	3443 TAMIAMI TRL
Second Line	:	SUITE D
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8159
Country	:	US
Telephone Number	:	941-629-3443
Fax Number	:	941-629-7616

Provider Business Practice Location Address
First Line	:	3443 TAMIAMI TRL
Second Line	:	SUITE D
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8159
Country	:	US
Telephone Number	:	941-629-3443
Fax Number	:	941-629-7616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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