MEDICARE: JOSHUA A MCKINNEY D.D.S

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	122300000X	Dentist	10045	TN

General Provider Information

NPI Number	:	1538545157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA A MCKINNEY D.D.S

Provider Business Mailing Address
First Line	:	1605 WILLIAMS RD
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4934
Country	:	US
Telephone Number	:	423-870-0791
Fax Number	:	423-875-6951

Provider Business Practice Location Address
First Line	:	1605 WILLIAMS RD
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4934
Country	:	US
Telephone Number	:	423-870-0791
Fax Number	:	423-875-6951

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

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	08/05/2015

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