MEDICARE: MCKINNEY DENTAL GROUP AND ORTHODONTICS, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407010697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKINNEY DENTAL GROUP AND ORTHODONTICS, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	3610 W UNIVERSITY DR STE 400
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-2952
Country	:	US
Telephone Number	:	972-548-9956
Fax Number	:	972-692-8468

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. KAVITHA NAGARURU
Credential	:	DMD
Telephone Number	:	972-548-9956

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	04/22/2021

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