MEDICARE: DR. JAMES DAVID MCKENZIE DDS

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	10952	FL

General Provider Information

NPI Number	:	1588877542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DAVID MCKENZIE DDS

Provider Business Mailing Address
First Line	:	382 N CAUSEWAY
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-5233
Country	:	US
Telephone Number	:	386-428-6468
Fax Number	:	386-428-4981

Provider Business Practice Location Address
First Line	:	382 N CAUSEWAY
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-5233
Country	:	US
Telephone Number	:	386-428-6468
Fax Number	:	386-428-4981

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

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

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